Cardiac Troponin T: Its Role in the Diagnosis of Clinically Suspected Acute Myocarditis and Chronic Dilated Cardiomyopathy in Children
Cardiac Troponin T: Its Role in the Diagnosis of Clinically Suspected Acute Myocarditis and Chronic Dilated Cardiomyopathy in Children
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心肌肌钙蛋白 T：其在临床疑似儿童急性心肌炎和慢性扩张型心肌病诊断中的作用
DOI：
10.1007/pl00021005
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发表时间：
2002
影响因子：
1.6
通讯作者：
C. Kangkagate
中科院分区：
文献类型：
--
作者：
J. Soongswang;K. Durongpisitkul;S. Ratanarapee;W. Leowattana;A. Nana;D. Laohaprasitiporn;S. Akaniroj;N. Limpimwong;C. Kangkagate
本研究旨在探讨血清心肌肌钙蛋白T(CTnT)水平作为鉴别儿童急性心肌炎和慢性扩张型心肌病的无创性指标的价值。心肌炎和扩张型心肌病在临床上很难区分。心内膜心肌活检被证明是非常有用的。然而，该过程的性质-侵袭性、耗时和有限的敏感性-引起了一些关注，特别是在儿科患者中。因此，我们试图寻找一种能迅速诊断急性心肌炎的替代方法。20例临床疑似心肌炎或扩张型心肌病患者和21例中度左向右分流充血性心力衰竭患者作为对照组。比较病史、体格检查、心电图、胸片、超声心动图、cTnT、肌酸激酶MB同工酶(CK-MB质量)和/或心内膜心肌活检。诊断心肌炎的金标准是心内膜心肌活检(达拉斯标准)和/或在6个月内从心血管问题中恢复。诊断为心肌炎(组1)10例，慢性扩张型心肌病(组2)10例。第1、2、3组血清cTnT中位数分别为0.088、0.010、0.010(0.010~0.550)ng/ml。CK-MB平均水平分别为18.35(7.14~70.00)、4.80(0.54~108.00)和2.26(0.95~7.06)ng/ml。第1、2组5例中2例和全部4例均经病理证实。心肌炎组cTnT和CK-MB水平显著高于扩张型心肌病组和左向右分流合并心力衰竭组。需要进一步的研究来评估区分这两种情况的最佳cTnT水平。
AbstractThis study was conducted to assess the use of the serum cardiac troponin T (cTnT) level as a noninvasive indicator to differentiate acute myocarditis and chronic dilated cardiomyopathy in pediatric patients. Myocarditis and dilated cardiomyopathy are clinically difficult to differentiate. Endomyocardial biopsy proved to be quite useful. However, the nature of the procedure—invasiveness, time-consuming, and limited sensitivity—caused some concerns, especially in pediatric patients. Hence, we attempted to find an alternative method that could give a prompt diagnosis of acute myocarditis. Twenty cases with clinically suspected myocarditis or dilated cardiomyopathy and a control group of 21 cases with moderate left-to-right shunt and congestive heart failure were recruited. History, physical examination, electrocardiogram, chest roentgenogram, echocardiogram, cTnT, creatine kinase MB isoenzyme (CK-MB mass), and/or endomyocardial biopsy were compared. The gold standard used to diagnose myocarditis is endomyocardial biopsy (Dallas criteria) and/or recovery from cardiovascular problems within 6 months of follow-up. Ten patients were diagnosed as having myocarditis (group 1) and 10 with chronic dilated cardiomyopathy (group 2). The control group of 21 cases was designated as group 3. The median serum cTnT levels were 0.088 (0.04–3.11), 0.010 (0.010–0.990), and 0.010 (0.010–0.550) ng/ml in groups 1, 2, and 3, respectively. The mean CK-MB mass level for groups, 1, 2, and 3 were 18.35 (7.14–70.00), 4.80 (0.54–108.00), and 2.26 (0.95–7.06) ng/ml. The study showed that both the cTnT and CK-MB mass levels were significantly higher in group 1 than either group 2 or group 3. Histopathology was studied in 9 cases. In 2 of 5 cases and in all 4 cases in group 1 and group 2 histopathology was pathologically proved. Levels of cTnT and CK-MB were significantly higher for myocarditis than for dilated cardiomyopathy and left-to-right shunt with CHF. Further study is needed to assess the optimum cTnT level for differentiating both conditions.