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目的探讨巨细胞病毒(CMV)肝炎患儿合并心肌损伤的心电图及心肌酶谱变化,为临床诊治提供一定的依据。方法 48例CMV肝炎患儿以入院时未予治疗前血CMV-DNA拷贝数≤1×104为组Ⅰ(25例),>1×104为组Ⅱ(23例),同时选择同期行体检的35例健康婴儿作为正常组,分析三组婴儿心电图及心肌酶谱变化。结果 48例CMV肝炎患儿中合并心肌损伤35例,占72.9%。心电图异常15例,分别为窦性心动过速11例,ST-T改变3例,房性早搏1例。组Ⅰ、组Ⅱ患儿治疗前谷草转氨酶(AST)、肌酸激酶(CK)、同工酶(CK-MB)、乳酸脱氢酶(LDH)均较正常组明显升高,差异有统计学意义(P<0.05);治疗前组Ⅱ较组Ⅰ患儿AST、CK、CK-MB升高,差异有统计学意义(P<0.05);组Ⅰ、组Ⅱ患儿治疗后较治疗前AST、CK、CK-MB、LHD均有所下降,差异有统计学意义(P<0.05);两组患儿治疗后与正常组心肌酶对比差异无统计学意义(P>0.05)。结论 CMV肝炎患儿易发生心肌损伤,病毒负荷越大,心肌损伤越重;其心电图改变多为非特异性,可通过CK-MB等心肌酶检测早期发现。给予及时治疗,心肌损伤绝大部分可恢复正常。
Objective To investigate the changes of electrocardiogram and myocardial enzymes in patients with cytomegalovirus (CMV) hepatitis complicated with myocardial injury, and to provide some evidences for clinical diagnosis and treatment. Methods 48 children with CMV hepatitis were enrolled in this study. Group Ⅰ (25 cases) and group Ⅱ (23 cases) with CMV-DNA copy number ≤1 × 104 before admission were enrolled. At the same time, 35 healthy infants as a normal group, analysis of three groups of infants ECG and myocardial zymogram changes. Results In 48 children with CMV hepatitis, 35 cases were complicated with myocardial injury, accounting for 72.9%. Electrocardiogram abnormalities in 15 cases, respectively, 11 cases of sinus tachycardia, ST-T changes in 3 cases, 1 case of atrial premature beats. The levels of AST, CK, CK-MB and LDH in group I and II were significantly higher than those in control group (P <0.05). Before treatment, the levels of AST, CK and CK-MB in group Ⅱ were significantly higher than those in groupⅠ (P <0.05) , CK, CK-MB and LHD decreased, the difference was statistically significant (P <0.05). There was no significant difference between the two groups in the level of myocardial enzymes and the normal group (P> 0.05). CONCLUSION: Myocardial injury is easy to occur in children with CMV hepatitis. The greater the viral load, the more severe the myocardial damage. The ECG changes are mostly nonspecific and can be detected early by CK-MB and other myocardial enzymes. Give timely treatment, the vast majority of myocardial injury can be restored to normal.