血清8-iso-PGF2α、C5a联合评估儿童心肌炎心肌损伤及预后的价值OA
Serum 8-iso-PGF2α and C5a joint ealuation of myocardial injury and prognosis in children with myocarditis
目的 探讨血清 8-异前列腺素 F2α(8-iso-PGF2α)与补体成分 5a(C5a)联合评估儿童心肌炎(MC)心肌损伤及预后的价值.方法 前瞻性选取2021 年1 月—2024 年6 月山西省儿童医院/山西省妇幼保健院心血管风湿科收治的MC 患儿120 例(MC 组),随访1 年,根据预后分为不良亚组32 例和良好亚组88 例.另按照1∶1比例选取同期健康体检儿童120 例(健康对照组).采用酶联免疫吸附法检测血清8-iso-PGF2α、C5a,顺磁性微粒化学发光免疫测定心肌损伤指标[心肌肌钙蛋白 I(cTnI)、肌酸激酶同工酶 MB(CK-MB)]水平;Pearson 相关分析 MC 患儿血清8-iso-PGF2α、C5a 与心肌损伤指标水平的相关性;多因素 Logistic 回归分析 MC 患儿预后不良的危险因素;受试者工作特征(ROC)曲线分析血清 8-iso-PGF2α、C5a 水平评估 MC 患儿预后不良的效能.结果 MC 组血清 8-iso-PGF2α、C5a、cTnI、CK-MB 水平均高于健康对照组(t/P=14.759/＜0.001、16.801/＜0.001、29.383/＜0.001、14.007/＜0.001);MC患儿血清 8-iso-PGF2α、C5a 水平均与 cTnI、CK-MB 水平呈正相关(r/P=0.708/＜0.001、0.637/＜0.001,0.699/＜0.001、0.625/＜0.001);不良亚组 C 反应蛋白(CRP)、cTnI、CK-MB、8-iso-PGF2α、C5a 水平均高于良好亚组(t/P=2.395/＜0.018、2.295/＜0.024、2.341/＜0.021、2.993/0.003、5.707/＜0.001);CRP 高、cTnI 高、CK-MB 高、8-iso-PGF2α 高、C5a 高为 MC 患儿预后不良的独立危险因素[OR(95%CI)=2.657(1.366～5.165)、4.658(1.672～12.982)、1.228(1.051～1.435)、1.047(1.024～1.070)、1.055(1.027～1.083)];血清 8-iso-PGF2α、C5a 水平及二者联合评估 MC 患儿预后不良的 AUC 分别为0.795、0.806、0.905,二者联合优于各自单独预测效能(Z/P=3.198/0.001、2.683/0.007).结论 MC 患儿血清 8-iso-PGF2α、C5a 水平升高与心肌损伤加重及预后不良相关,血清8-iso-PGF2α、C5a 水平联合检测对预后有较高的评估效能.
Objective To investigate the combination of serum 8-iso-prostaglandin F2α(8-iso-PGF2α)and comple-ment component 5a(C5a)in evaluating myocardial injury and prognosis in children with myocarditis(MC).Methods A total of 120 children with MC(MC group)admitted to the Department of Cardiovascular and Rheumatology of Shanxi Chil-dren's Hospital(Shanxi Maternal and Child Health Hospital)from January 2021 to June 2024 were prospectively selected,and 120 healthy children(healthy control group)were selected at a 1∶1 ratio.Serum 8-iso-PGF2α and C5a levels were detected by enzyme-linked immunosorbent assay.Myocardial injury markers[cardiac troponin I(cTnI),creatine kinase isoenzyme MB(CK-MB)]were measured by paramagnetic particle chemiluminescence immunoassay.Pearson correlation analysis was used to analyze the correlation between serum 8-iso-PGF2α,C5a,and myocardial injury markers in children with MC.Factors in-fluencing prognosis and the efficacy of serum 8-iso-PGF2α and C5a levels in evaluating poor prognosis in children with MC were analyzed.Results Compared with the healthy control group,serum levels of 8-iso-PGF2α,C5a,cTnI,and CK-MB were significantly higher in the MC group(t=14.759,16.801,29.383,14.007,all P<0.001).Serum 8-iso-PGF2α and C5a le-vels in children with MC were positively correlated with cTnI and CK-MB levels(r=0.708,0.699,0.637,0.625,all P<0.001).The 1-year poor prognosis rate among the 120 children with MC was 26.67%(32/120).Levels of C-reactive protein(CRP),cTnI,CK-MB,8-iso-PGF2α,and C5a were significantly higher in the poor prognosis subgroup than in the good prognosis subgroup(t=2.395,2.295,2.341,2.993,5.707,all P<0.05).Elevated CRP,elevated cTnI,elevated CK-MB,elevated 8-iso-PGF2α,and elevated C5a were independent risk factors for poor prognosis in children with MC[OR(95%CI)=2.657(1.366-5.165),4.658(1.672-12.982),1.228(1.051-1.435),1.047(1.024-1.070),1.055(1.027-1.083)].The AUCs of serum 8-iso-PGF2α,C5a,and their combination in evaluating poor prognosis in children with MC were 0.795,0.806,and 0.905,respectively.The combined detection was superior to each individual marker(Z=3.198,2.683;P=0.001,0.007).Conclusion Elevated serum 8-iso-PGF2α and C5a levels are associated with aggravated myocardial injury and poor prognosis in chil-dren with myocarditis.Combined detection of serum 8-iso-PGF2α and C5a provides higher predictive value for prognosis assessment.
孙晶;杨蕊华;孙晔;刘丽华;崔涛
030000 太原,山西省儿童医院/山西省妇幼保健院心血管风湿科030000 太原,山西省儿童医院/山西省妇幼保健院心血管风湿科030000 太原,山西省儿童医院/山西省妇幼保健院心血管风湿科030000 太原,山西省儿童医院/山西省妇幼保健院心血管风湿科030000 太原,山西省儿童医院/山西省妇幼保健院心血管风湿科
医药卫生
心肌炎心肌损伤8-异前列腺素F2α补体成分5a预后儿童
MyocarditisMyocardial injury8-iso-prostaglandin F2αComplement component 5aPrognosisChildren
《疑难病杂志》 2026 (8)
923-927,5
山西省卫生健康科研课题(2022047) Shanxi Province Health Research Project(2022047)
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