Analysis Of Etiology And Characteristics Of Children With Elevated Creatine Kinase

Objective:1.To understand the overall etiological composition ratio of Creatine Kinase（CK）elevation in children and the etiological composition ratio of different age groups and different genders.2.To understand the differences in CK levels of common causes of CK elevation in children and their value for diagnosis.Methods:A retrospective analysis was conducted on the clinical data of140 patients with creatine kinase increase greater than 1.5 times the upper limit of normal value who were hospitalized in the Department of Pediatrics of a hospital from January 2020 to January 2023.After the final diagnosis was made,the etiological component of increased creatine kinase in 140 subjects was analyzed and grouped according to age and sex.The children were grouped by disease type,and the highest creatine kinase values of all children were collected before treatment,and the differences in creatine kinase levels of different causes were analyzed.IBM SPSS Statistics 25.0 software was used to compare the laboratory data,and P<0.05 was considered statistically significant.The pooled data were statistically analyzed to derive the overall etiological composition ratio of CK elevation in children and the etiological composition ratio of different age groups and different genders,the differences in CK levels of common etiologies and their value for diagnosis.Results:1.Overall data:A total of 145 cases of children with increased CK who met the inclusion criteria were collected in this study,among which 5 cases were lost to follow-up,and 140 cases were actually and finally included in the study.Among the actual included cases,100（71.4%）were males and 40（28.6%）were females;the age distribution ranged from 1 day to 14 years,with70（50.0%）cases≤6 years and 70（50.0%）cases>6 years,and the creatine kinase levels ranged from 304 to 196445 U/L.2.Overall etiological distribution:Among 140 children with elevated creatine kinase,progressive muscular dystrophy accounted for the highest proportion in the overall etiology distribution,accounting for 56 cases（40.0%）,followed by children with acute benign myositis,accounting for 25 cases（17.9%）,and myocarditis was the third cause,accounting for 22 cases（15.7%）.Among 140 children with increased creatine kinase,53.6%were caused by myopathy and 46.4%by non-myopathy.Among them,the progressive muscular dystrophy,a total of 56 patients（40.0%）,of myopathy venereal disease due to the first place,followed by dermatomyositis 8 cases（5.7%）,the third is the metabolic myopathy 7 cases（5.0%）.Benign in non myopathy STD for acute benign myositis in children accounted for most,a total of 25 cases（17.9%）,myocarditis,a total of 22 cases（15.7%）,rhabdomyolysis third,a total of 14cases（10.0%）.3.Distribution of etiology in different age groups:In this study,140children with increased creatine kinase with inclusion criteria were divided into≤6 years and>6 years groups,the composition of etiology was not identical in different age groups（x²=25.119,P=0.001）among which the main etiologies of increased creatine kinase in≤6 years group were progressive muscular dystrophy（45.7%）,acute benign myositis in children（21.4%）,myocarditis（11.4%）.The main etiologies of creatine kinase increase in the age>6 years group were progressive muscular dystrophy（34.3%）,myocarditis（20.0%）,and trauma and injury（18.6%）,where the percentage of rhabdomyolysis was significantly lower in the≤6 years group than in the>6 years group,and the difference was statistically significant（x²=25.119,P<0.05）,and the percentage of the remaining etiologies did not differ significantly across age groups.Progressive muscular dystrophy and acute benign myositis in children,which accounted for the largest proportion of myopathic and non-myopathic etiologies in this study,were selected to compare their differences in different age groups,where creatine kinase levels in progressive muscular dystrophy showed statistically significant differences in different age groups（P=0.017）,while acute benign myositis in children showed no statistically significant differences in different age groups（P=0.082）.The mean serum CK values of 56 children with progressive muscular dystrophy of different ages were counted;the age of onset ranged from 1 to 12years,CK ranged from 1011 to 146770 U/L,and serum creatine kinase values tended to decrease approximately with increasing age.4.Etiological distribution of different genders:140 children with increased creatine kinase included in the criteria were grouped by gender in this study,among which the main diseases of increased creatine kinase in male children were progressive muscular dystrophy（56.0%）,acute benign myositis（15.0%）and myocarditis（12.0%）.The main causes of increased creatine kinase in female children were acute benign myositis（25.0%）,myocarditis（25.0%）,and dermatomyositis（17.5%）.The gender composition was not identical in different years（x²=65.663,P<0.05）.The proportion of progressive muscular dystrophy in male children was higher than that in female children（x²=37.333,P<0.001）,and the proportion of dermatomyositis in female children was higher than that in male children,the difference was statistically significant（x²=9.705,P=0.002）.The proportion of metabolic myopathy in female children was higher than that in male children（x²=9.026,P=0.003）,and there was no significant difference in the proportion of residual causes between different genders.5.Differences in creatine kinase levels for common causes:Creatine kinase levels of all etiology in this study were expressed in the form of M(P₂₅～P₇₅),and CK level differences among major etiology were compared.Creatine muscle enzyme levels in progressive muscular dystrophy were significantly higher than those in inflammatory myopathy（P<0.001）,but there was no statistical significance in creatine muscle enzyme levels between inflammatory myopathy and metabolic myopathy（P>0.05）.In the non-myopathy etiology,the creatine kinase level of rhabdomyolysis in children was higher than that of myocarditis（P<0.05）,and there was a statistically significant difference between acute benign myositis in children and rhabdomyolysis factors（P<0.05）.Conclusions:1.The causes of increased creatine kinase can be divided into two categories:non-myopathic and myopathic.Among them,the causes of myopathic CK increase mainly include progressive muscular dystrophy,inflammatory myopathy,metabolic myopathy and so on.The causes of non-myopathic CK elevation mainly include acute benign myositis in children,rhabdomyolysis,myocarditis,drug toxicity,etc.When there are no clear diagnostic clues in clinical diagnosis,they can be considered in this order.2.The etiologic composition ratio in different age groups is different and the level of creatine kinase in progressive muscular dystrophy is different in different age groups.3.The etiological component ratio of different genders is different.4.Among all etiologies,progressive muscular dystrophy and rhabdomyolysis in children caused by increased levels of CK are the most significant.