摘要
目的分析动态心电图联合血清脑钠肽(BNP)、肌酸激酶同工酶(CK-MB)水平在评估呼吸道感染并发病毒性心肌炎患者病情严重程度中的临床价值。方法回顾性选取2018年1月至2022年12月浙江大学医学院附属邵逸夫医院收治的125例呼吸道感染患者,依据是否并发病毒性心肌炎分为并发组(71例)、未并发组(54例),对比动态与常规心电图的特征,分析并发组与未并发组入院时血清BNP、CK-MB水平,对比不同心肌炎病情患者的动态心电图、血清BNP及CK-MB,分析其联合诊断价值。结果动态心电图中房性早搏及窦性心动过速等检出率高于常规心电图[38.03%(27/71)比22.54%(16/71)、28.17%(20/71)比14.08%(10/71)](P<0.05);并发组入院时血清BNP、CK-MB水平均高于未并发组[(104.26±10.75)ng/L比(54.11±5.69)ng/L、(17.89±1.86)U/L比(13.46±1.42)U/L],差异有统计学意义(P<0.05);呼吸道感染并发重症病毒性心肌炎患者(37例)动态心电图中房性早搏、窦性心动过速、短阵室性心动过速、一度房室传导阻滞、ST段改变、QRS低电压检出率及入院时血清BNP、CK-MB水平均高于并发轻症病毒性心肌炎患者(34例)[51.35%(19/37)比23.53%(8/34)、43.24%(16/37)比11.76%(4/34)、32.43%(12/37)比11.76%(4/34)、29.73%(11/37)比8.82%(3/34)、43.24%(16/37)比14.71%(5/34)、24.32%(9/37)比5.88%(2/34)、(107.19±10.56)ng/L比(101.08±10.18)ng/L、(18.33±1.85)U/L比(17.41±1.76)U/L],差异有统计学意义(P<0.05);以临床病理诊断为准,动态心电图、入院时BNP、入院时CK-MB、三者联合诊断急性上呼吸道感染并发病毒性心肌炎的Kappa值分别是0.784、0.765、0.733、0.879,且联合检测灵敏度、准确度更高。结论动态心电图联合血清BNP、CK-MB能较好评估呼吸道感染并发心肌炎患者病情严重程度,可加以监测。
Objective To analyze the clinical value of dynamic electrocardiogram combined with serum brain natriuretic peptide(BNP)and creatine kinase isoenzyme(CK-MB)levels in evaluating the severity of respiratory tract infection complicated with viral myocarditis.Methods A total of 125 patients with respiratory tract infection who were admitted to the Affiliated Run Run Shaw Hospital of Medical School,Zhejiang University from January 2018 to December 2022 were selected retrospectively.They were divided into the complication group(71 cases)and the non-complication group(54 cases)according to whether they were complicated with viral myocarditis.Dynamic and conventional electrocardiogram characteristics were compared.Serum BNP and CK-MB levels in the complication group and the non-complication group at admission were analyzed.Dynamic electrocardiograms and serum BNP and CK-MB levels of patients with different severity of myocarditis were comparatively analyzed.The value of combined diagnosis was analyzed.Results The detection rates of atrial premature beats and sinus tachycardia by dynamic electrocardiogram were higher than those by conventional electrocardiogram:38.03%(27/71)vs.22.54%(16/71),28.17%(20/71)vs.14.08%(10/71)(P<0.05).Serum BNP and CK-MB levels in the complication group were higher than those in the non-complication group:(104.26±10.75)ng/L vs.(54.11±5.69)ng/L,(17.89±1.86)U/L vs.(13.46±1.42)U/L(P<0.05).The detection rates of atrial premature beats,sinus tachycardia,burst ventricular tachycardia,first-degree atrioventricular block,ST segment change and low QRS voltage,serum BNP and CK-MB levels in patients with respiratory tract infection complicated with severe viral myocarditis(37 cases)were higher than those in patients with mild viral myocarditis(34 cases):51.35%(19/37)vs.23.53%(8/34),43.24%(16/37)vs.11.76%(4/34),32.43%(12/37)vs.11.76%(4/34),29.73%(11/37)vs.8.82%(3/34),43.24%(16/37)vs.14.71%(5/34),24.32%(9/37)vs.5.88%(2/34),(107.19±10.56)ng/L vs.(101.08±10.18)ng/L,(18.33±1.85)U/L vs.(17.41±1.76)U/L(P<0.05).Compared with clinical pathological diagnosis,Kappa values of dynamic electrocardiogram,BNP at admission,CK-MB at admission and combination of the three for diagnosing acute upper respiratory tract infection complicated with viral myocarditis were 0.784,0.765,0.733 and 0.879.The sensitivity and accuracy of combined diagnosis were higher.Conclusions Dynamic electrocardiogram combined with serum BNP and CK-MB can better help to evaluate the severity of respiratory tract infection complicated with myocarditis.Therefore,they are worthy of monitoring.
作者
刘童铭
韩冰洁
房阳亮
Liu Tongming;Han Bingjie;Fang Yangliang(Electrocardiogram Room,the Affiliated Run Run Shaw Hospital of Medical School,Zhejiang University,Hangzhou 310000,China;Department of Cardiology,Ningbo Medical Central Lihuili Hospital,Ningbo 315100,China)
出处
《中国医师进修杂志》
2024年第3期226-230,共5页
Chinese Journal of Postgraduates of Medicine
