Zhang Yangyang, Cao Yinyin, Xin Yi, Liu Yongming
Department of Pediatrics, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, China.
Clinical Laboratory, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, Shandong, China.
Front Pediatr. 2024 Sep 2;12:1445651. doi: 10.3389/fped.2024.1445651. eCollection 2024.
To investigate the incidence of myocardial injury in children with critically ill children without primary cardiac disease and the association between elevated cardiac troponin I (cTnl) and creatine kinase MB (CK-MB) concentrations and disease progression and prognosis to guide early treatment.
The serum cTnI and CK-MB concentrations of 292 children with critically ill children without primary cardiac disease in Yantai Yuhuangding Hospital between January 2021 and January 2024 were retrospectively analyzed within 24 h after entering the Pediatric Intensive Care Unit (PICU). The children were divided into normal and abnormal groups according to the myocardial marker results. The abnormal group was further divided into the cTnI-elevated, CK-MB-elevated, single-elevated (cTnI- or CK-MB-elevated) and double-elevated (cTnI- and CK-MB-elevated) groups. The differences in the clinical indicators and their relationships with prognosis for the groups were compared.
The incidence of myocardial injury among the critically ill children without primary cardiac disease was 55.1%. The incidence of myocardial injury in children with infectious diarrhea combined with moderate and severe dehydration reached 85.19%. The pediatric critical illness score; frequency of use of vasoactive drugs; hypotension, shock, heart failure, respiratory failure, and multiple organ dysfunction syndrome; and mortality indexes differed significantly for the normal and abnormal myocardial marker groups ( < 0.05). The single-elevated and normal groups only showed a difference in mortality ( < 0.017). The cTnI and CK-MB concentrations were negatively correlated with prognosis ( < 0.01).
Myocardial injury, as evidenced by elevated cardiac biomarkers, is common in critically ill children without primary cardiac illness. cTnI and CK-MB are associated with outcomes. Shock, heart failure, and multiple organ dysfunction syndromes are independently associated with simultaneous elevations of CK-MB and cTnI concentrations. Further prospective studies are needed to elucidate the clinical utility of these biomarkers.
探讨无原发性心脏病的危重症患儿心肌损伤的发生率，以及心肌肌钙蛋白I（cTnl）和肌酸激酶同工酶MB（CK-MB）浓度升高与疾病进展及预后的关系，以指导早期治疗。
回顾性分析2021年1月至2024年1月在烟台毓璜顶医院收治的292例无原发性心脏病的危重症患儿进入儿科重症监护病房（PICU）后24小时内的血清cTnI和CK-MB浓度。根据心肌标志物结果将患儿分为正常组和异常组。异常组进一步分为cTnI升高组、CK-MB升高组、单项升高组（cTnI或CK-MB升高）和双项升高组（cTnI和CK-MB升高）。比较各组临床指标的差异及其与预后的关系。
无原发性心脏病的危重症患儿心肌损伤发生率为55.1%。感染性腹泻合并中重度脱水患儿心肌损伤发生率达85.19%。正常和异常心肌标志物组的儿科危重症评分、血管活性药物使用频率、低血压、休克、心力衰竭、呼吸衰竭和多器官功能障碍综合征以及死亡率指标差异有统计学意义（P<0.05）。单项升高组和正常组仅在死亡率方面存在差异（P<0.017）。cTnI和CK-MB浓度与预后呈负相关（P<0.01）。
心脏生物标志物升高所证实的心肌损伤在无原发性心脏病的危重症患儿中很常见。cTnI和CK-MB与预后相关。休克、心力衰竭和多器官功能障碍综合征与CK-MB和cTnI浓度同时升高独立相关。需要进一步的前瞻性研究来阐明这些生物标志物的临床应用价值。
