轮状病毒肠炎心肌损害【轮状病毒肠炎并心肌损害102例临床分析】
[摘要] 目的 探讨轮状病毒（rotavirus，RV）肠炎致心肌损伤的临床特点，指导其诊断和治疗。 方法 回顾分析2007年2月～2011年12月在本院治疗的轮状病毒肠炎患儿265例，均做心电图、心肌酶谱检测。 结果 102例患儿心肌酶增高，心电图有异常，心肌损伤病例占同期轮状病毒肠炎患儿的38.5%。其心肌酶的增高与脱水的程度和病情轻重相关。 结论 轮状病毒肠炎并心肌损害多属于潜在性和亚临床型心肌损害，在临床表现上并无特殊性，有面色苍白、精神萎靡症状及合并脱水、酸中毒的患儿更易发生心肌损害，诊断上依靠心肌酶及心电图检查，只要做到早期发现、早期治疗，轮状病毒肠炎并心肌损害预后较好。
[关键词] 轮状病毒肠炎；心肌损害；临床分析；心肌酶
[中图分类号] R542.2 [文献标识码] A [文章编号] 1674-4721（2012）07（c）-0027-02
Clinical analysis of rotavirus enteritis complicated with myocardial injure in 102 cases
LI Xiuyun1 ZHANG Qing2
1.Department of Pediatrics, the Second People′s Hospital of Guizhou Province, Guiyang 550004, China; 2.Department of Pediatrics, Liupanshui People′s Hospital of Guizhou Province, Liupanshui 553001, China
[Abstract] Objective To investigate the clinical characteristics of rotavirus enteritis which induced myocardial injury and in order to guide the diagnosis and treatment. Methods The clinical characteristics of 265 children with rotavirus enteritis complicated with myocardial injure in our hospital were analyzed retrospectively from February 2007 to December 2011. Their electrocardiogram and myocardial enzymes were checked. Results Serum myocardial enzyme increased in 102 cases of children with rotavirus enteritis complicated with myocardial injure. And the electrocardiogram were abnormal. Myocardial injury cases accounted for 38.5% of children with rotavirus enteritis in the same period. The myocardial enzymes and dehydration of increased the degree and illness weight related. Conclusion Myocardial injure in children with rotaviral enteritis is mostly underlying and subclinical. The clinical manifestations of pale-looking and cachexia with dehydration and acidosisin is easier to infected myocardial injure. It′s diagnosis depends on serum myocardial enzyme or electrocardiogram. Only when rotavirus enteritis complicated with myocardial injure can be found and treated earlier and have good results.
[Key words] Rotavirus enteritis; Myocardial injure; Clinical analysis; Myocardial enzyme
轮状病毒（rotavirus，RV）是世界各地婴幼儿腹泻的重要病原体，其发生率和严重程度居秋、冬季腹泻的首位。轮状病毒不仅可引起肠道内的感染，还可引起其他全身多系统病变[1]。因此及早发现并及时处理轮状病毒肠炎的胃肠外并发症，对减少患儿痛苦、减轻家庭负担有重要意义。现对2007年2月～2011年12月本院治疗的轮状病毒肠炎患儿的临床资料进行回顾性分析，报道如下：
1 资料与方法
1.1 一般资料
收集2007年2月～2011年12月本院治疗的轮状病毒肠炎患儿265例，年龄6个月～3岁，急性期发病，均以胃肠道感染为首发临床表现，除外合并其他感染的患儿，具有典型腹泻症状，大便常规无红细胞和白细胞，有少量脂肪球，经酶联免疫吸附试验（ELISA）方法检测，大便轮状病毒抗体均阳性，所有病例均符合轮状病毒肠炎的诊断标准[2]。265例轮状病毒肠炎患儿中经心肌酶及心电图检查发现合并心肌损害102例，其中，男60例，占58.8%，女42例，占41.2%。发病年龄6个月～2岁72例，2～3岁30例。根据第6版《儿科学》指定的诊断标准[3]，将患儿分为轻型、重型，其中，轻型21例，重型81例。入院时102例患儿均有原发病不能解释的非特异性症状面色苍白、精神萎靡，重型伴有不同程度的脱水并酸中毒。