论文部分内容阅读
目的 :通过连续观测急性病毒性心肌炎 ( VMC)患儿血清肌酸激酶同工酶 ( CK- MB)和心肌肌钙蛋白 ( c Tn I)与外周血淋巴细胞等的变化 ,探讨 VMC心肌细胞受损的机制。方法 :对 32例急性期和 1 2例迁延期及慢性期 VMC患儿血清 c Tn I、CK- MB,外周血 T淋巴细胞亚群、B淋巴细胞、自然杀伤细胞 ,肠道病毒 RNA,柯萨奇病毒 ( CBV)特异性抗体 Ig M( CBV- Ig M) ,淋巴细胞增殖活性 ( PI) ,补体 C3,左室射血分数 ( LVEF)进行测定。结果 :1急性期 VMC病程 <2周时 ,血清 c Tn I,CK- MB水平与对照组比较显著升高 (均 P <0 .0 1 ) ,CD3 ,CD4 ,CD8,CD4 /CD8,CD4 9,CD56细胞 ,PI,C3接近正常水平 ,血清 CBV- Ig M、外周血淋巴细胞 CBV- RNA检出阳性率较对照组明显增高 (χ2 值分别为 1 .667和 8.53,P值分别 >0 .0 5和 <0 .0 5) ;2病程 4～ 8周时 ,血清 c T-n I、CK- MB水平再次出现显著增高 ,与对照组比较 ,CD3 、CD4 、CD8、CD56、L VEF均显著降低 (均 P<0 .0 5) ,CD4 /CD8升高 ( P <0 .0 5) ,CBV- Ig M及 CBV- RNA检出率明显下降。结论 :血清 c Tn I、CK- MB是小儿急性 VMC时心肌损伤较敏感和特异的血清标志物 ,病程早期血清水平的升高可能为病毒的直接作用 ,晚期可能与机体免疫功能紊乱引起心肌损伤有关。
OBJECTIVE: To investigate the changes of serum CK-MB, cTnI and peripheral blood lymphocytes in children with acute viral myocarditis (VMC) Damage mechanism. Methods: Serum levels of cTn I, CK-MB, peripheral blood T lymphocyte subsets, B lymphocytes, natural killer cells, enterovirus RNA, 32 cases of VMC in 32 patients with acute and chronic VMC, (CBV) IgM, lymphocyte proliferative activity (PI), complement C3 and left ventricular ejection fraction (LVEF) were measured. Results: The levels of cTn I and CK-MB in the acute phase of VMC <2 weeks were significantly higher than those in the control group (all P <0 01), CD3, CD4, CD8, CD4 / CD8 and CD4 9 , CD56 cells, PI and C3 were close to the normal levels. The positive rate of CBV-Ig in peripheral blood lymphocytes and CBV-Ig M in peripheral blood was significantly higher than that in control group (χ2 = 1.67 and 8.53, P> 0 respectively). 0, 5 and <0. 05). The levels of cTn I and CK-MB in serum were significantly increased again after 4 to 8 weeks of course of disease. Compared with the control group, the levels of CD3, CD4, CD8, CD56 and L VEF were significantly decreased (All P <0.05), CD4 / CD8 increased (P <0.05), and the detection rates of CBV-Ig M and CBV-RNA decreased significantly. Conclusion: Serum cTnI, CK-MB is a sensitive and specific serum marker of myocardial injury in children with acute VMC. The early serum level rise may be a direct role of the virus in the course of the disease. The later may be related to myocardial damage caused by immune dysfunction related.