CAJ | 학술논문

目的：探讨高敏肌钙蛋白T（hs-cTnT）和肌酸激酶同工酶质量（CK-MB mass）对儿童病毒性心肌炎（VMC）的诊疗价值。方法选择VMC患儿67例，分别于患儿出现心累、气促等临床症状2～4 d以及治疗1周后检测血清hs-cTnT和CK-MB mass水平；同时测定54例急性胃肠炎患儿、53例上呼吸道感染患儿、50例肺炎患儿及55名健康体检儿童（正常对照组）的血清hs-cTnT和CK-MB mass水平并做比较。采用受试者工作特征（ROC）曲线评估hs-cTnT和CK-MB mass联合检测及单项检测时的敏感性和特异性。结果急性胃肠炎组、急性上呼吸道感染组、肺炎组、正常对照组及VMC组入院时的血清hs-cTnT水平[中位数（四分位数）]分别为5．68（3．83，8．22）、5．03（3．00，6．57）、5．52（3．44，10．19）、4．81（3．22，6．67）和58．57（29．77，160．20）pg/mL；血清CK-MB mass水平[中位数（四分位数）]分别为2．29（1．72，2．96）、2．26（1．41，3．48）、2．59（1．81，3．62）、1．83（1．42，3．05）和7．40（4．32，13．26）ng/mL；各组间hs-cTnT和CK-MB mass水平差异均有统计学意义（H值分别为115．15、83．79，P均＜0．001），且VMC组入院时hs-cTnT和CK-MB mass水平明显高于急性胃肠炎组、急性上呼吸道感染组、肺炎组和正常对照组（P均＜0．001）。VMC组治疗后hs-cTnT和CK-MB mass水平虽低于入院时（P均＜0．001），但仍高于急性胃肠炎组、急性上呼吸道感染组、肺炎组和正常对照组（P均＜0．001）。ROC曲线显示VMC入院时与治疗后hs-cTnT和CK-MB mass联合检测的敏感性高于单独检测hs-cTnT（P＜0．05），但特异性差异无统计学意义（P＞0．05）。结论 hs-cTnT用于诊断VMC有较高的敏感性和特异性，和CK-MB mass联合检测有更高的辅助诊断价值。
목적：탐토고민기개단백T（hs-cTnT）화기산격매동공매질량（CK-MB mass）대인동병독성심기염（VMC）적진료개치。방법선택VMC환인67례，분별우환인출현심루、기촉등림상증상2～4 d이급치료1주후검측혈청hs-cTnT화CK-MB mass수평；동시측정54례급성위장염환인、53례상호흡도감염환인、50례폐염환인급55명건강체검인동（정상대조조）적혈청hs-cTnT화CK-MB mass수평병주비교。채용수시자공작특정（ROC）곡선평고hs-cTnT화CK-MB mass연합검측급단항검측시적민감성화특이성。결과급성위장염조、급성상호흡도감염조、폐염조、정상대조조급VMC조입원시적혈청hs-cTnT수평[중위수（사분위수）]분별위5．68（3．83，8．22）、5．03（3．00，6．57）、5．52（3．44，10．19）、4．81（3．22，6．67）화58．57（29．77，160．20）pg/mL；혈청CK-MB mass수평[중위수（사분위수）]분별위2．29（1．72，2．96）、2．26（1．41，3．48）、2．59（1．81，3．62）、1．83（1．42，3．05）화7．40（4．32，13．26）ng/mL；각조간hs-cTnT화CK-MB mass수평차이균유통계학의의（H치분별위115．15、83．79，P균＜0．001），차VMC조입원시hs-cTnT화CK-MB mass수평명현고우급성위장염조、급성상호흡도감염조、폐염조화정상대조조（P균＜0．001）。VMC조치료후hs-cTnT화CK-MB mass수평수저우입원시（P균＜0．001），단잉고우급성위장염조、급성상호흡도감염조、폐염조화정상대조조（P균＜0．001）。ROC곡선현시VMC입원시여치료후hs-cTnT화CK-MB mass연합검측적민감성고우단독검측hs-cTnT（P＜0．05），단특이성차이무통계학의의（P＞0．05）。결론 hs-cTnT용우진단VMC유교고적민감성화특이성，화CK-MB mass연합검측유경고적보조진단개치。
Serum levels of hs-cTnT and CK-MB mass were determined in 67 patients with VMC (measured within clinical symptoms for 2- 4 d and after treatment for 1 week ),54 children with acute gastroenteritis,53 children with acute upper respiratory tract infection,50 children with acute pneumonia and 55 healthy children (healthy control group).The receiver operating characteristic (ROC ) curve was used to evaluate the sensitivity and specificity of hs-cTnT determination,CK-MB mass determination and the combined determination of hs-cTnT and CK-MB mass.Results Serum levels of hs-cTnT in acute gastroenteritis group,acute upper respiratory tract infection group,acute pneumonia group,healthy control group and VMC group [median (quartile)]were 5.68(3.83,8.22),5.03(3.00,6.57), 5.52(3.44,10.19),4.81(3.22,6.67)and 58.57(29.77,160.20)pg/mL,respectively,and serum levels of CK-MB mass [median (quartile)]were 2.29(1 .72,2.96),2.26(1 .41 ,3.48),2.59(1 .81 ,3.62),1 .83(1 .42, 3.05)and 7.40(4.32,1 3.26)ng/mL,respectively.There was statistical significance for hs-cTnT and CK-MB mass among the groups (H=1 1 5.1 5 and 83.79,P<0.001 ).Serum levels of hs-cTnT and CK-MB mass in VMC group after treatment were lower than those within clinical symptoms for 2-4 d (P<0.001 ),which were significantly higher than those in the acute gastroenteritis group,acute upper respiratory tract infection group,acute pneumonia group and healthy control group (P<0.001 ).The ROC curve showed that the combined determination of hs-cTnT and CK-MB mass had higher sensitivity than hs-cTnT determination (P<0.05),but without significant specificity (P>0.05).Conclusions The hs-cTnT has high diagnosis sensitivity and specificity for VMC,and the combined determination of hs-cTnT and CK-MB mass has high diagnosis significance.