1 海南省妇女儿童医学中心儿科，海口 570206
目的：探讨轮状病毒(rotavirus，RV)感染腹泻患儿发生心肌损伤后心肌酶学指标变化及相关危险因素。方法：选取2017年1月至2019年4月海南省妇女儿童医学中心收治的87例RV感染腹泻患儿的临床资料作为RV组，同期87例腹泻但RV检测阴性患儿的临床资料作为对照组；对比两组的血清肌酸激酶(creatine kinase，CK)、肌酸激酶同工酶(creatine kinase isoenzymes-MB，CK-MB)、乳酸脱氢酶(lactate dehydro-genase，LDH)、谷草转氨酶(alanine transaminase，AST)、α-羟丁酸脱氢酶(α-hydroxybutyrate dehydrogenase，α-HBDH)、肌钙蛋白I(cardiac troporlin I，cTnI)、肌钙蛋白T(cardiac troponin T，cTnT)的水平；并依据心电图、心脏彩超及患儿临床表现将RV组分为心肌损伤组38例、未损伤组49例，对比两组的一般资料，分析引起RV感染腹泻患儿心肌损伤的危险因素。结果：RV组患儿的血清CK、CK-MB、LDH、AST、α-HBDH、cTnI、cTnT及心电图Qt离散度水平均高于对照组(P<0.05)；经单因素分析，发生心肌损伤的RV感染腹泻患儿血清钠、血清钾水平低于正常范围的人数比例显著高于非心肌损伤组(P<0.05)；经logistic多因素分析，RV感染腹泻患儿发生心肌损伤独立危险因素是血清钠水平、血清钾水平降低(P<0.05)。结论：RV感染腹泻患儿发生心肌损伤的风险较高，心肌酶学指标早期即发生改变，同时低血钠、低血钾可增大RV感染腹泻患儿发生心肌损伤的风险。
Changes of myocardial enzymes in rotavirus infected children with myocardial injury and diarrhea and its risk factors
CorrespondingAuthor: WANG Shuzhen
This work was supported by the Hainan Province Health and Family Planning Industry Research Project, China (19A200074).
Objective: To investigate the changes of myocardial enzymes and related risk factors after myocardial injury in children with positive rotavirus (RV) infection. Methods: The clinical data of 87 children with positive RV infection admitted to Hainan Women and Children’s Medical Center from January 2017 to April 2019 were selected as the RV group, and the clinical data of 87 children with diarrhea but negative RV test during the same period were selected as the control group. The level of creatine kinase (CK), creatine kinase isoenzymes-MB (CK-MB), lactate dehydro-genase (LDH), alanine transaminas (AST), α-hydroxybutyrate dehydrogenase (α-HBDH), cardiac troporlin I (cTnI) and cardiac troponin T (cTnT) were measured and compared between the two groups. According to electrocardiogram, color Doppler echocardiography and clinical manifestations of children, the RV group was divided into a myocardial injury group (38 cases) and a non-injury group (49 cases). The general data of the 2 groups were compared and the risk factors of myocardial injury in children with RV were analyzed. Results: The serum levels of CK, CK-MB, LDH, AST, α-HBDH, CTnI, cTnT, and ECG Qt dispersion in the RV group were higher than those in the control group (P<0.05). By univariate analysis, the proportion of serum sodium and potassium levels below normal range in RV-infected diarrhea children with myocardial injury was significantly higher than that in non-myocardial injury group (P<0.05). Logistic multivariate analysis showed that the independent risk factors for myocardial injury in children with diarrhea caused by RV infection were the decrease of serum sodium level and serum potassium level (P<0.05). Conclusion: Children with RV-positive diarrhea have a higher risk of suffering from myocardial injury, and changes in myocardial enzymatic parameters occur at an early stage. At the same time, low serum sodium and potassium can increase the risk of suffering from myocardial injury in children with RV-positive diarrhea.
rotavirus; myocardial injury; myocardial enzymology; risk factors