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目的分析严重急性呼吸综合征(SARS)患者心肌酶的变化特点。方法用常规方法,检测84例(9例死亡,8例插管,30例无创通气,37例无辅助通气)SARS患者的心肌酶指标。结果SARS患者发病3～6d起,心肌酶开始上升,但上升的幅度差异很大。18例(21.4%)SARS患者,整个病程血清心肌酶均在正常参考范围。α-HBDH、AST、LDH、LD-1、CK和CK-MB的异常率分别为60.7%、53.6%、77.4%、44.0%、38.1%和28.4%。SARS患者心肌酶随病情变化而改变,病情越重,升幅越大,异常率越高,死亡组和插管组患者心肌酶平均峰值和异常率明显高于无创通气组(P<0.001),无创通气组患者又明显高于无辅助通气组(P<0.001)。除死亡组外,多数患者心肌酶在4周内恢复正常。结论大部分SARS患者心肌酶异常,部分出现心肌损害,临床上应予足够的重视。
Objective To analyze the changes of myocardial enzymes in patients with severe acute respiratory syndrome (SARS). Methods The myocardial enzymes of 84 patients (9 died, 8 intubated, 30 noninvasive ventilation and 37 without ventilatory support) were detected by routine methods. Results From 3 to 6 days after the onset of SARS, myocardial enzymes began to rise, but the magnitude of the increase was quite different. Eighteen cases (21.4%) of SARS patients, the whole course of serum myocardial enzymes are in the normal reference range. The abnormal rates of α-HBDH, AST, LDH, LD-1, CK and CK-MB were 60.7%, 53.6%, 77.4%, 44.0%, 38.1% and 28.4%, respectively. The myocardial enzymes in patients with SARS changed with the changes of the disease. The more severe the disease was, the greater the rate of increase was and the higher the abnormal rate was. The mean peak myocardial anomalies and peak abnormalities in death and intubation groups were significantly higher than those in noninvasive ventilation group (P <0.001) Patients in the ventilation group were significantly higher than those in the non-assisted ventilation group (P <0.001). In addition to the death group, the majority of patients with myocardial enzymes returned to normal within 4 weeks. Conclusion Most patients with SARS have abnormal myocardial enzymes and some have myocardial damage, which should be paid enough attention in clinic.