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目的研究分析EV-71感染重症手足口病患儿,尤其是神经源性肺水肿患儿的心肌损伤特征,探讨心肌损伤标志物对此类患儿病情监测、预后评估的意义。方法收集2012.5-2015.9入住我院感染科病房并接受治疗的手足口病患儿的临床资料,系统整理后进行回顾性分析。共71例患儿纳入分析,均由市级手足口病专家组确诊,均为静脉血EV71-Ig M(+)。分为3组:手足口病肺水肿组共17例,同时期的手足口病脑干脑炎组共21例、同时期的手足口病普通病毒性脑炎组共33例。年龄5月-7岁,平均1.80岁,其中男44例,女27例,男女之比为1.63:1。结果肺水肿组与脑干脑炎组浓度值比较,心肌损伤标志物的浓度值差异存在显著性(P<0.01);肺水肿组的CKMB(肌酸激酶的同工酶)比起脑干脑炎组浓度值要明显升高,但差异没有显著性(P>0.05)。肺水肿组与病毒性脑炎组浓度值比较、脑干脑炎组与病毒性脑炎组浓度值比较,心肌损伤标志物、CKMB的浓度值差异均存在显著性(P<0.05)。17例肺水肿患儿死亡7例,放弃治疗5例,脑干脑炎组放弃治疗2例,二者死亡率差异存在显著性(χ2=15.06,P值<0.01);而普通病毒性脑炎经治疗后基本好转出院。肺水肿组相较于脑干脑炎组、普通病毒性脑炎组,心肌损伤标志物浓度值均存在显著差异,预后也最差。结论心肌损伤标志物升高是手足口病患儿病情进展、预后评估的一项重要预警指标。伴有心肌损伤标志物、心肌酶学明显升高的手足口病患儿,更易出现顽固性休克、循环衰竭、甚至死亡。尤其是肌钙蛋白Ⅰ在正常值3倍以上者,应高度重视,及时救治。
Objective To study the characteristics of myocardial injury in children with EV-71 severe hand-foot-mouth disease, especially in children with neurogenic pulmonary edema, and to explore the significance of myocardial injury markers in the monitoring and prognosis evaluation of such children. Methods The clinical data of children with hand-foot-mouth disease admitted to our hospital from May 2012 to May 2015 were collected and systematically analyzed retrospectively. A total of 71 patients were included in the analysis, and all were diagnosed by the municipal expert group of hand, foot and mouth disease, all of whom were EV71-Ig M (+) venous blood. Divided into three groups: 17 cases of hand, foot and mouth disease pulmonary edema group, the same period of hand, foot and mouth disease brain stem encephalitis group, a total of 21 cases, the same period hand, foot and mouth disease common viral encephalitis group a total of 33 cases. The age of May-7 years old, average 1.80 years old, 44 males and 27 females, the ratio of male to female was 1.63: 1. Results Compared with the encephalitogenic group, the difference of the concentration of myocardial injury markers in pulmonary edema group was significant (P <0.01). CKMB (creatine kinase isoenzyme) in pulmonary edema group was significantly higher than that in brainstem group Yan group concentration was significantly higher, but the difference was not significant (P> 0.05). Compared with the concentration of encephalitis group in edema group and viral encephalitis group, there was significant difference in the concentrations of myocardial injury markers and CKMB between encephalitogenic group and viral encephalitis group (P <0.05). 17 cases of pulmonary edema in children died in 7 cases, give up treatment in 5 cases, 2 cases of brain stem encephalitis group give up treatment, the difference was significant (P <0.01), while the common viral encephalitis The basic improvement after discharge from the hospital. Pulmonary edema group compared with brainstem encephalitis group, common viral encephalitis group, myocardial injury markers concentration values were significantly different, the prognosis is also the worst. Conclusion The increase of myocardial injury markers is an important predictor of progression of patients with hand-foot-mouth disease and prognosis evaluation. Patients with HFMD, a marker of myocardial injury, and a marked increase in cardiac enzymes, are more likely to have refractory shock, circulatory failure and even death. Especially troponin I in the normal value of 3 times or more, should attach great importance to timely treatment.