正五聚蛋白3与特发性扩张型心肌病的相关性

Relationship between PTX3 and idiopathic dilated cardiomyopathy

目的:研究正五聚蛋白(PTX)3与特发性扩张型心肌病的相关性。方法:选择30例特发性扩张型心肌病患者为病例组,30例同期健康体检者为对照组。采用酶联免疫吸附法检测血浆中PTX3、抗β1肾上腺素受体抗体、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、超敏C反应蛋白(hs-CRP)以及人N端前脑钠素(NT-proBNP)水平,并进行心功能分级,测量左室舒张末期内径(LVEDD)及左室射血分数(LVEF)。比较2组PTX3水平,并对病例组中PTX3水平与其他指标进行相关性分析,同时对病例组中PTX3与hs-CRP的特异性和敏感性进行比较。结果:病例组血浆PTX3水平显著高于对照组[(3.39±2.57)ng/ml∶(1.18±0.77)ng/ml),P<0.01]。病例组中,心功能Ⅲ级、Ⅳ级血浆PTX3水平均明显高于对照组[(2.53±0.84)ng/ml∶(1.18±0.77)ng/ml,(4.64±3.66)ng/ml∶(1.18±0.77)ng/ml,均P<0.05],且心功能Ⅳ级PTX3水平高于心功能Ⅲ级(P<0.05)。病例组中血浆PTX3水平与抗β1肾上腺素受体抗体(r=0.551,P=0.001)、hs-CRP(r=0.600,P=0.005)、TNF-α(r=0.775,P=0.000)、IL-6(r=0.514,P=0.006)、NT-proBNP(r=0.453,P=0.004)及LVEDD(r=0.546,P=0.002)均呈正相关,与LVEF(r=-0.582,P=0.001)呈负相关。利用ROC曲线下面积对病例组中血浆PTX3与hs-CRP的灵敏性和特异性比较发现,PTX3和hs-CRP的ROC曲线下面积分别为0.932和0.686。结论:扩张型心肌病患者血浆PTX3水平升高,随心功能分级的增加而增加。血浆PTX3对扩张型心肌病炎性活动识别的敏感性和特异性优于hs-CRP,可作为扩张型心肌病较好的一个炎症指标。

Objective： To investigate the relationship between PTX3 and idiopathic dilated cardiomyopathy （IDCM）. Method： Thirty IDCM patients （case group） and thirty healthy controls （control group） were enrolled. The PTX3, TNF-β, IL-6, hs-CRP, β1 adrenergic receptor autoantibodies and NT-proBNP were measured by sandwich ELISA. Heart function of patients in case group was classified, and the LVEDD and LVEF were measured. The relationship between PTX3 and other indicators were analyzed. The specificity and sensibility of PTX3 and hs-CRP were compared in case group. Result： PTX3 in case group was significantly higher than that in control group [（3.39±2.57） ng/ml vs （1. 18±0.77）ng/ml, P〈0.01]. In case group, PTX3 in NYHA III and IV were significantly higher than those in control group [（2.53±0.84）ng/ml vs （1.18±0. 77）ng/ml, （4.64±3.66）ng/ ml vs （1.18±0. 77）ng/ml, both P〈0. 057, and PTX3 in NYHA IV was significantly higher than that in NYHA III （P〈0.05）. There was positive correlation between plasma PTX3 and β1 adrenergic receptor autoantibodies （r=0. 551, P=0. 001）, hs-CRP （r=0. 600, P=0. 005）, TNF-a （r=0. 775, P=0. 000）, IL-6 （r=0. 514, P= 0. 006）, NT-proBNP （r=0. 453, P=0. 004） and LVEDD （r=0. 546, P=0. 002）, and there was negative correlation between plasma PTX3 and LVEF （r=-0. 582, P=0. 001）. The areas under ROC curve of plasma PTX3 and hs-CRP were respectively 0. 932 and 0. 686. Conclusion：The plasma PTX3 in IDCM is significantly higher, and it is increased dependently on the severity of NYHA. The specificity and sensibility of plasma PTX3 is superior to hs CRP in the diagnosis of IDCM, and it may be a better inflammation marker.