Evaluation Of Clinical Value Of CK-MB Mass And RDW In Children With Myocarditis

Part 1:The value of CK-MB mass and RDW in the evaluation of children with myocarditisObjective:To study the clinical data of myocarditis in children admitted to our hospital from January 2016 to December 2019,and analyze the creatine kinase isoenzyme MB mass,red blood cell distributionand other indicators and the relationship between children’s myocarditis and the severity of the disease,pro’vide a reference for the evaluation of children’s myocarditis.Methods:101 children with myocarditis admitted to the Children’s Hospital of Soochow University from January 2016 to December 2019 were selected as the myocarditis group(including 71 cases of non-severe myocarditis and 30 cases of severe myocarditis),and non-myocarditis during the same period 40 cases of hospitalized children were the control group.Retrospective analysis of clinical general data of children in each group(including age,gender,first symptoms,etiological indicators,days of onset),electrocardiogram,echocardiography,and CK-MB mass,troponin I,blood-derived inflammation index RDW,average red blood cell volume,platelet distribution width,average platelet volume,neutrophil to lymphocyte ratio,lymphocyte to monocyte ratio and other levels.Using SPSS25.0 and other software for data analysis,P<0.05 indicates that the difference is statistically significant.Results:(1)A total of 101 children with myocarditis were included in this data,including 56 males and 45 females,with a male to female ratio of 1.24:1,an age range of 1 to 183 months,and a median age of 50.0 months.15 cases(14.9%)in February,17 cases(16.8%)in March,13 cases(12.9%)in April,and 13 cases(12.9%)in November were more common;the first symptom was vomiting in 26 cases(25.7%)),fever in 23 cases(22.8%),chest discomfort in 20 cases(19.8%),cough in 14 cases(13.9%),abdominal pain in 9 cases(8.9%),mental insufficiency in 7 cases(6.9%)and so on.39 cases(38.6%)of infants and young children and 23 cases(22.8%)of preschool age were more common with digestive and respiratory symptoms,and 39 cases(38.6%)of school age were more common with cardiovascular and digestive symptoms.There were 98 cases(97.0%)with abnormal ECG changes,54 cases(53.5%)with arrhythmia,50 cases with ST-T changes(49.5%),26 cases with conduction block(25.7%)and other changes were common;72 cases(71.3%)Echocardiographic changes occurred,with 22 cases(21.8%)of enlarged left ventricle and 22 cases(21.8%)of decreased left ventricular systolic function.(2)The levels of CK-MB mass and cTnI in the myocarditis group on admission were significantly higher than those in the non-myocarditis group(P<0.05);but there were no significant differences in the levels of RDW,MCV,PDW,MPV,NLR,and LMR of the two groups of children on admission(P>0.05).(3)The onset time of 101 children with myocarditis on admission was 3.5±2.7 days on average.Among them,72 patients had onset of disease within 4 days upon admission,and the remaining 29 patients had onset of disease greater than 4 days upon admission.Among the children with myocarditis that occurred within 4 days,56 cases(77.8%)were positive for CK-MB mass,44 cases(61.1%)were positive for cTnI,of which 37 cases(51.4%)were positive at the same time,the positive rate of CK-MB mass was significantly higher cTnI(P<0.05);in children with myocarditis more than 4 days old,17 cases(58.6%)were positive for CK-MB mass,16 cases(55.2%)were positive for cTnI,of which 13 cases(44.8%)were positive at the same time,CK-There was no statistical difference between the positive rates of MB mass and cTnI(P>0.05).(4)Grouped according to the severity of the disease,30 cases of severe myocarditis and 71 cases of non-severe myocarditis;the CK-MB mass,cTnI,RDW levels in the severe myocarditis group were significantly higher than those in the non-severe myocarditis group(P<0.05);but the two groups There was no statistically significant difference in the levels of MCV,PDW,MPV,NLR,and LMR(P>0.05).(5)Evaluation of predictive efficacy of myocardial injury indicators and blood-derived inflammation indicators for severe myocarditis:①Multi-factor logistic regression analysis showed that:cTnI(OR=1.358,95%CI:1.069～1.726),RDW(OR=1.797,95%CI:1.084～2.980)are independent predictors of severe myocarditis(P<0.05).②Draw the cTnI,RDW indicators and the receiver operating characteristic curve of severe myocarditis.The area under the ROC curve of cTnI is 0.734,the cut-off value is 0.21ng/ml,the sensitivity is 85.20%,and the specificity is 65.10%;the AUC of RDW is 0.739,The cutoff value is 12.95%,the sensitivity is 85.20%,and the specificity is 58.70%.The area under the curve of cTnI and RDW was not statistically different(P>0.05).Conclusion:1.Children’s myocarditis is more frequent in winter and spring,and the first symptoms are more common with extracardiac manifestations.Children whose main manifestations are extracardiac symptoms such as respiratory tract and gastrointestinal tract are accompanied by paleness and mental insufficiency.Improve relevant inspections.2.The positive rate of CK-MB mass detection was higher than cTnI within 4 days of childhood myocarditis.3.The levels of RDW and cTnI in children with severe myocarditis are significantly higher than those in children with non-severe myocarditis,and are independent predictors of severe myocarditis.The predictive value of RDW for severe myocarditis is equivalent to cTnI.RDW,as a simple and economic blood-derived inflammation index,can be used as a new index to identify severe myocarditis and help primary hospitals to assess the condition of myocarditis.Part 2:Clinical analysis of causes of CK-MB mass rise and evaluation of CK-MB mass/CK diagnostic value in myocardial damageObjective:To conduct clinical analysis on children with elevated CK-MB mass,and to explore the diagnostic value of creatine kinase isoenzyme mass/creatine kinase ratio in myocardial damage,so as to provide a reference for the clinical application of CK-MB mass.Methods:The clinical data of 238 children with elevated CK-MB mass in the Department of Cardiology,Children’s Hospital of Soochow University from January 2019 to July 2019 were retrospectively analyzed.They were divided into 52 cases of myocardial damage group(including myocarditis)15 cases,37 cases of myocardial injury)and 186 cases of non-myocardial injury group,and statistical analysis of the creatine kinase,CK-MB mass and CK-MB mass/CK indicators detected at admission,P<0.05 indicates that the difference is statistically significant.Results:(1)Among the 238 children with elevated CK-MB mass,there were 139 males and 99 females with an age range of 1 to 176 months and a median age of 44.5 months.The following respiratory infections were 122 cases(51.3%),myocardial injury 37 cases(15.5%),myositis 18 cases(7.6%),gastroenteritis 17 cases(7.1%),myocarditis 15 cases(6.3%),upper respiratory tract infection 10 Cases(4.2%)are more common.(2)Among the 238 children with elevated CK-MB mass,a total of 184 children(77.3%)were under the age of 3 years,of which 39 children had myocardial damage,accounting for 21.2%;patients over the age of 3 years There were 54 children(22.7%),including 13 children with myocardial damage,accounting for 24.1%.(3)Of the 186 children with non-myocardial damage,106 children(73.1%)had respiratory infections under the age of 3,17 had gastroenteritis(11.7%),and 8 had pertussis-like syndrome(5.5%).See;more than 16 children(39.0%)with lower respiratory tract infections,16(39.0%)myositis,and 5(12.2%)upper respiratory tract infections in children over 3 years old.(4)A total of 52 cases(21.8%)in the myocardial damage group and 186 cases(78.2%)in the non-myocardial damage group showed no significant difference in gender,age,CK-MB mass,and CK levels between the two groups(P>0.05).The CK-MB mass/CK ratio in the myocardial damage group was significantly higher than that in the non-myocardial damage group(P<0.05).The ROC curve of CK-MB mass/CK and myocardial damage was drawn.The area under the curve(A of CK-MB mass/CK was 0.590,the cutoff value was 0.065 ug/U,the sensitivity was 42.30%,and the specificity was 75.30%.Conclusion:1.The most common cause of elevated CK-MB mass in children is respiratory infection,and myocardial damage accounts for only about 20%to 25%.2.Respiratory tract infection is the primary cause of elevated CK-MB mass in children with non-myocardial damage,followed by gastrointestinal infections under 3 years of age and myositis over 3 years of age.3.CK-MB mass/CK has certain reference value in the differential diagnosis of cardiogenic injury and non-cardiogenic injury.When CK-MB mass/CK≥6.5%,it is necessary to be aware of the possibility of cardiogenic injury,even if myocarditis cannot be reached the diagnostic criteria also need to extend the follow-up observation time.