论文部分内容阅读
目的探讨新生儿脐血心肌酶及肌钙蛋白检测对新生儿缺血缺氧性心肌损伤诊断的意义。方法选择2003年9月至2004年2月间在我院分娩的234例新生儿,于分娩后即刻留取脐血行肌酸激酶(CK)、肌酸激酶心型同工酶(CK-MB)、心肌肌钙蛋白Ⅰ(cTnI)的测定及分析。结果新生儿脐血 CK、CK-MB、cTnI 较成人正常值的范围有明显升高,其分布均呈现偏态分布,中位值 CK为256 U/L、CK-MB 为6.45 ng/ml、cTnI 为0.02 ng/ml,95%正常参考值范围 CK 为120～552 U/L、CK-MB 为2～19.5 ng/ml、cTnI 为0.00～0.60 ng/ml。胎儿窘迫及母体合并症对各项心肌酶水平无显著影响(P>0.05)。产钳组 CK(中位值265 U/L)明显高于顺产组(220 U/L)及剖宫产(204 U/L)组,但分娩方式对 CK-MB、cTnI 无影响。早产组 CK、CK-MB 显著低于足月分娩组(P<0.01),但早产对cTnI 无影响。234例中共有7例发生新生儿缺血缺氧性心肌损伤,其脐血心肌酶值均在我们得到的正常范围内。结论新生儿脐血心肌酶应采用与成人不同的标准,需进行大样本的研究来建立新生儿的脐血心肌酶正常值范围;另一方面,不能单纯根据脐血心肌酶升高判断是否存在新生儿缺血缺氧性心肌损伤。
Objective To investigate the significance of neonatal cord blood myocardial enzyme and troponin detection in the diagnosis of neonatal hypoxic-ischemic myocardium injury. Methods A total of 234 newborn infants delivered in our hospital from September 2003 to February 2004 were randomly divided into three groups: cord blood creatine kinase (CK), creatine kinase type I (CK-MB) , Cardiac troponin Ⅰ (cTnI) were measured and analyzed. Results The ranges of CK, CK-MB and cTnI of neonatal umbilical cord blood were significantly higher than those of normal adults, and their distributions were skewed. The median CK was 256 U / L and CK-MB was 6.45 ng / ml. The cTnI was 0.02 ng / ml and the 95% normal reference range was 120 to 552 U / L for CK, 2 to 19.5 ng / ml for CK-MB and 0.00 to 0.60 ng / ml for cTnI. Fetal distress and maternal complications had no significant effect on the level of myocardial enzymes (P> 0.05). The forceps clamp group had a median CK of 265 U / L, which was significantly higher than that of the 220 U / L and 204 U / L groups. However, delivery mode had no effect on CK-MB and cTnI. Preterm birth CK, CK-MB was significantly lower than the full-term delivery group (P <0.01), but preterm delivery had no effect on cTnI. A total of 234 cases of neonatal hypoxic-ischemic myocardial injury occurred in 7 cases, the umbilical cord blood enzyme values ?? are within our normal range. Conclusion Newborn cord blood myocardial enzymes should be used in different standards with adults, large samples need to be studied to establish the normal range of neonatal umbilical cord blood enzymes; the other hand, can not be simply based on umbilical cord blood enzymes to determine the existence of elevated Neonatal hypoxic ischemic myocardial injury.