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目的 分析严重急性呼吸综合征 (SARS)并发心脏损伤的临床表现 ,探讨其可能的原因及机理。方法 选择 2 0 0 3年 3月至 5月在北京佑安医院住院的SARS患者 14 3例 ,按有无基础疾病将患者分为两组 ,第 1组 11例为原有心血管疾病者 ;第 2组 13 2例为无心血管疾病患者 ;观察其临床表现特点 ,常规检测血常规、血气分析和心肌酶谱等实验室指标和心电图 ,采用双抗体夹心ELISA法测定 3 2例患者血清白介素 (IL) 1β ,IL 2 ,IL 4,IL 6,IL 8,IL 10和肿瘤坏死因子 α水平 ,以 15例健康医护人员作为对照。 3例患者行尸检心脏病理学检查。结果 14 3例SARS患者中 ,118例存在一项以上血清酶异常 ,以α 羟丁酸脱氢酶 (α HBDH)和乳酸脱氢酶 (LDH )升高最常见 ,其次为天门冬氨酸氨基转移酶 (AST) ;分别有 3 4例和 19例患者出现短暂的血清肌酸激酶 (CK )和肌酸激酶同工酶(CK MB)轻度升高 ,主要见于重型患者和第 1组患者 ;心肌酶和炎症因子升高多出现于病程最初 2周 ,并随病情好转而下降 ;第 1组患者LDH和CK升高程度显著高于第 2组 ;最常见的心电图异常为窦性心动过速 ,其次为ST T动态改变及窦性心动过缓、房室传导阻滞等 ;病理学检查显示心肌及心肌间质水肿、间质细胞轻度增生、少量淋巴细胞浸润等非特异性炎性改变。结
Objective To analyze the clinical manifestations of severe acute respiratory syndrome (SARS) complicated with heart injury and to explore its possible causes and mechanism. Methods A total of 143 SARS patients hospitalized in Beijing You’an Hospital from March to May in 2003 were divided into two groups according to the presence or absence of underlying diseases. The first group included 11 patients with original cardiovascular disease. Two groups of 132 patients without cardiovascular diseases were observed. The clinical manifestations, blood routine, blood gas analysis, myocardial enzymes and other laboratory indexes and electrocardiogram were detected routinely. The serum levels of interleukin (IL) ) 1β, IL 2, IL 4, IL 6, IL 8, IL 10 and tumor necrosis factor-α, with 15 cases of health care workers as control. Three patients underwent autopsy of cardiac pathology. Results Among the 143 SARS patients, 118 cases had more than one serum enzyme abnormality, the most common one was α-hydroxybutyrate dehydrogenase (α HBDH) and lactate dehydrogenase (LDH), followed by aspartate amino (AST) .There was a slight increase in serum creatine kinase (CK) and creatine kinase MB (CK MB) in 34 and 19 patients, respectively, mainly in severe and group 1 patients ; Myocardial enzymes and inflammatory cytokines increased more in the first 2 weeks of the course of disease, and with the condition improved and decreased; the first group of patients with elevated levels of LDH and CK were significantly higher than the second group; the most common ECG abnormalities of sinus tachycardia Followed by ST T dynamic changes and sinus bradycardia, atrioventricular block, etc .; pathological examination showed myocardial and myocardial interstitial edema, interstitial cells mild hyperplasia, a small amount of lymphocytic infiltration and other non-specific inflammatory changes . Knot