Bogovič Petra, Lotrič-Furlan Stanka, Ogrinc Katarina, Avšič Županc Tatjana, Korva Miša, Kastrin Andrej, Trampuš Bakija Alenka, Strle Klemen, Strle Franc
Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Infect Dis (Lond). 2024 Jun;56(6):504-509. doi: 10.1080/23744235.2024.2335349. Epub 2024 Apr 2.
Since some patients with tick-borne encephalitis (TBE) have pronounced myalgias, and since myositis is reported in diseases such as dengue, we performed systematic search for abnormalities of muscle enzymes in a group of patients in whom the presence of tick-borne encephalitis virus (TBEV) RNA in the first phase of the disease was demonstrated and who developed second phase of TBE.
Total leukocyte and platelet blood counts were determined routinely at the initial examination during the first and the second phase of TBE. Activity of aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatine kinase (CK), myoglobin and troponin was determined from the available stored serum specimens; the first and second phase disease specimens were tested simultaneously.
Of 24 patients with biphasic course of TBE, 83% had leukopenia, 65% thrombocytopenia, 83% elevated AST and 4% elevated ALT level. Furthermore, 33% had elevated serum CK, 26% myoglobin and 22% troponin activity; at least one of the muscle enzymes was elevated in 42% of patients. Leukopenia, thrombocytopenia, elevated liver enzymes and elevations of CK and myoglobin were present in the initial phase but resolve later, while troponin abnormalities were also found in the second phase of TBE.
The present study exposes that in addition to previously known leukopenia, thrombocytopenia and increased liver enzymes activity, the initial phase of TBE is relatively often associated also with elevated muscle enzymes. Clinical relevance of these findings remains to be determined.
鉴于一些蜱传脑炎（TBE）患者有明显的肌痛，且登革热等疾病也有关于肌炎的报道，我们对一组疾病第一阶段检测到蜱传脑炎病毒（TBEV）RNA且发展为TBE第二阶段的患者进行了肌肉酶异常的系统研究。
在TBE第一阶段和第二阶段的初次检查时常规测定全血细胞计数和血小板计数。从可用的储存血清标本中测定天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、肌酸激酶（CK）、肌红蛋白和肌钙蛋白的活性；同时检测第一阶段和第二阶段疾病的标本。
在24例有双相病程的TBE患者中，83%有白细胞减少，65%有血小板减少，83%的AST升高，4%的ALT水平升高。此外，33%的患者血清CK升高，26%的患者肌红蛋白升高，22%的患者肌钙蛋白活性升高；42%的患者至少有一种肌肉酶升高。白细胞减少、血小板减少、肝酶升高以及CK和肌红蛋白升高在疾病初始阶段出现，但随后消失，而肌钙蛋白异常也在TBE第二阶段被发现。
本研究表明，除了先前已知的白细胞减少、血小板减少和肝酶活性增加外，TBE初始阶段相对常见的还伴有肌肉酶升高。这些发现的临床意义仍有待确定。
