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  • Title: [Comparison analysis of muscle enzymes in children with myocarditis and Duchene/Becker muscular dystrophy].
    Author: Zhang Y, Wang H, Yu X, Xing Y, Wang C, He R.
    Journal: Zhong Nan Da Xue Xue Bao Yi Xue Ban; 2016 Sep 28; 41(9):984-91. PubMed ID: 27640799.
    Abstract:
    OBJECTIVE: To compare the changes in muscle enzyme between children with myocarditis and Duchene/Becker muscular dystrophy (DMD/BMD), and to seek the explanations for variation.
 METHODS: The retrospective analysis for 83 myocarditis children (myocarditis group) and 69 DMD/BMD children (DMD/BMD group), who were collected from Department of Pediatric of Shengjing Hospital affiliated to China Medical University since January 2008 to May 2015, was carried out. At the same time, 24 healthy children from the Department of Pediatric Development served as a control group. The examination indexes included creatine kinase (CK), creatine kinase-isoenzyme MB (CK-MB), creatine kinase isoenzyme MB mass (CK-MB mass), cardiac troponin I (cTnI) and high-sensitive-cTnT (hs-cTnT).
 RESULTS: 1) In the myocarditis group, the CK increased from 100 to 1 000 U/L, reached a peak after 5 days, which lasted for a week and then dropped to the normal; the CK-MB reached a peak after 5 to 7 days and dropped to the normal a month later; the CK-MB mass reached a peak on the first day and dropped to the normal after 3 weeks; the cTn reached to a peak after 5 days and dropped to the normal after about 17 days; hs-cTnT reached to a peak on the first day and dropped to the normal after about 19 days. 2) In the DMD/BMD group, the CK increased significantly and 27 cases had a CK value of more than 10 000 U/L. After the treatment for 1 to 2 weeks, their enzyme rose again after a slight drop. In terms of cTnI, 6 cases showed a moderate increase, 5 of them couldn't drop to the normal level until more than 3 weeks later; the hs-cTnT increased in the 45 cases, which lasted for more than 3 weeks in the 31 cases of them and showed a tendency of persisting increase.
 CONCLUSION: The cTnI and hs-cTnT rise significantly and possess wider observation window than CK and CK-MB mass in myocarditis children, with more sensitive and specific changes. The myocardial damage can occur before myasthenia and keep this trend for a long time in the DMD/BMD children. The trend of cTnI change in myocarditis children is similar to hs-cTnT, while hs-cTnT in DMD/BMD children is more sensitive than cTnI. 目的：通过对心肌炎及进行性肌营养不良(Duchene/Becker muscular dystrophy，DMD/BMD)患儿不同时间肌酶转归的对比分析，探索其变化规律。方法：回顾性分析2008年1月至2015年5月就诊于中国医科大学盛京医院儿科的心肌炎患者83例(心肌炎组)及DMD/BMD患者69例(DMD/BMD组)，对照组24例为同期发育儿科门诊体检儿童。检测内容包括肌酸激酶(creatine kinase，CK)、肌酸激酶同功酶(creatine kinase isoenzyme MB，CK-MB)、肌酸激酶同功酶质量(CK-MB mass)、肌钙蛋白(cardiac troponin，cTn)I及超敏肌钙蛋白T(high-sensitive-cTnT，hs-cTnT)。 结果：1)心肌炎组CK升高数百到数千U/L，5 d内达高峰，持续约1周后降至正常；CK-MB 在5~7 d达高峰，1个月左右降至正常；CK-MB mass在发病第1天即达高峰，约3周降至正常；cTnI 明显升高，5 d内达高峰， 17 d左右降至正常；hs-cTnT明显升高，第1天即可以达到峰值，19 d左右降至正常。2)DMD/BMD组CK升高明显，27例超过1×104 U/L，经过1~2周治疗后各项酶指标轻度降低，之后可再次升高；6例cTnI轻度升高，其中6例中又有5例超过3周不能降至正常；45例hs-cTnT升高，其中31例升高超过3周且有逐渐升高趋势。 结论：心肌炎组cTn升高明显，且峰值持续时间较长，较其他心肌标志物观察窗宽，具有高度的敏感性及特异性。DMD/BMD组CK升高幅度最大，治疗后轻度下降多复升。DMD/BMD组心肌损伤可以在肌无力发生前出现，且多数持续存在。心肌炎组cTnI和hs-cTnT改变规律相似，而DMD/BMD组hs-cTnT远比cTnI敏感。.
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