本文選題：病毒性心肌炎 + 兒童�。� 參考：《山東大學(xué)》2012年碩士論文

【摘要】：目的： 病毒性心肌炎的發(fā)病機(jī)制尚未完全闡明,目前認(rèn)為病毒的直接損傷和病毒感染介導(dǎo)的免疫反應(yīng)導(dǎo)致的心肌損傷是其主要發(fā)病機(jī)制,其中T細(xì)胞介導(dǎo)的免疫反應(yīng)起重要作用。在T細(xì)胞活化所需要的共刺激信號(hào)通路中,CD40-CD40L是重要的共刺激信號(hào)分子,sCD40L是CD40L的可溶性形式,可與CD40結(jié)合而起作用。超敏C反應(yīng)蛋白(hsCRP)是用超敏方法檢測(cè)到的低濃度CRP,其靈敏度較CRP高。本研究旨在通過(guò)檢測(cè)病毒性心肌炎患兒治療前后外周血sCD40L與hsCRP含量的變化,探討sCD40L與hsCRP在病毒性心肌炎中的臨床意義。 方法： 選擇30例臨床確診為病毒性心肌炎的患兒作為病例組,30例健康兒童作為對(duì)照組,檢測(cè)所有兒童外周血sCD40L和hsCRP的含量,其中病例組患兒治療2周后再次檢測(cè),并將sCD40L和hsCRP含量變化與患兒心肌酶、心電圖、心臟解剖等進(jìn)行對(duì)比分析。 結(jié)果： 1.病毒性心肌炎患兒治療前外周血中sCD40L含量(8.10±2.08)ng/ml明顯高于對(duì)照組(3.85±1.28)ng/ml(P0.05),治療后無(wú)明顯下降(P0.05)。 2.病毒性心肌炎患兒治療前外周血中hsCRP含量(12.42±3.40)mg/L,明顯高于對(duì)照組(1.80±1.07)mg/L(P0.05),治療后明顯下降(P0.05)。 3.病毒性心肌炎患兒外周血中sCD40L升高者,心肌酶升高、心電圖異常、心腔擴(kuò)大及室壁運(yùn)動(dòng)減弱的發(fā)生率明顯高于sCD40L正常者(P均0.05)。 4.病毒性心肌炎患兒外周血中hsCRP升高者,心肌酶升高、心電圖異常、心腔擴(kuò)大及室壁運(yùn)動(dòng)減弱的發(fā)生率明顯高于hsCRP正常者(P均0.05)。 結(jié)論： 1.病毒性心肌炎患兒外周血中sCD40L含量升高,且與患兒心肌酶升高、心電圖異常、心腔擴(kuò)大及室壁運(yùn)動(dòng)減弱的發(fā)生率相關(guān),表明其在一定程度上能反映病毒性心肌炎的病情。 2.病毒性心肌炎患兒外周血中hsCRP的含量升高,治療后下降,且與患兒心肌酶升高、心電圖異常、心腔擴(kuò)大及室壁運(yùn)動(dòng)減弱的發(fā)生率相關(guān),表明hsCRP隨病毒性心肌炎患兒的病情和病程而變化,可作為臨床輔助診斷指標(biāo)。
[Abstract]:Objective: The pathogenesis of viral myocarditis has not been fully elucidated. At present, it is considered that the direct damage of virus and the myocardial injury induced by viral infection are the main pathogenesis of viral myocarditis, and T cell mediated immune response plays an important role. CD40-CD40L is an important costimulatory signal molecule, which is a soluble form of CD40L and can bind to CD40 in the costimulatory signal pathway needed for T cell activation. Hypersensitive C-reactive protein (hsCRP) is a low concentration CRP detected by hypersensitivity method, and its sensitivity is higher than that of CRP. The purpose of this study was to investigate the clinical significance of sCD40L and hsCRP in viral myocarditis by detecting the changes of sCD40L and hsCRP in peripheral blood of children with viral myocarditis before and after treatment. Methods: Thirty children with viral myocarditis were selected as the control group and 30 healthy children as the control group. The levels of sCD40L and hsCRP in peripheral blood of all the children were detected again after 2 weeks of treatment. The contents of sCD40L and hsCRP were compared with myocardial enzymes, electrocardiogram and cardiac anatomy. Results: 1. The content of sCD40L in peripheral blood of children with viral myocarditis before treatment was 8.10 鹵2.08)ng/ml significantly higher than that of control group (3.85 鹵1.28 ng / ml P0.05N). 2. The content of hsCRP in peripheral blood of children with viral myocarditis was 12.42 鹵3.40 mg / L before treatment, which was significantly higher than that of control group (1.80 鹵1.07g / L), and decreased significantly after treatment. 3. In children with viral myocarditis, the incidence of increased sCD40L, abnormal electrocardiogram, enlarged heart cavity and decreased wall motion in peripheral blood was significantly higher than that in patients with normal sCD40L (P < 0.05). 4. In children with viral myocarditis, the incidence of increased hsCRP, abnormal electrocardiogram, enlarged heart cavity and decreased wall motion in peripheral blood was significantly higher than that in patients with normal hsCRP (P < 0.05). Conclusion: 1. The content of sCD40L in peripheral blood of children with viral myocarditis was increased, which was related to the increase of myocardial enzymes, abnormal electrocardiogram, enlargement of heart cavity and weakening of ventricular wall motion, which indicated that it could reflect the condition of viral myocarditis to a certain extent. 2. The content of hsCRP in peripheral blood of children with viral myocarditis increased and decreased after treatment, and was related to the incidence of myocardial enzymes, abnormal electrocardiogram, dilated heart cavity and decreased wall motion in children with viral myocarditis. The results showed that hsCRP varied with the condition and course of viral myocarditis, and could be used as an auxiliary diagnostic index.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R725.4

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