E-选择素在肺炎支原体肺炎患儿心肌损伤中的诊断价值

Value of E-selectin in diagnosis of myocardial damage in children with Mycoplasma pneumoniae pneumonia

目的探讨E-选择素（E-selectin,ES）在肺炎支原体肺炎（mycoplasma pneumoniae pneumonia,MPP）患儿心肌损伤中的诊断价值。方法运用前瞻性、双盲及连续招募的研究方法,检测126例MPP中合并心肌损伤（心肌损伤组）36例和MPP无心肌损伤（对照组）90例的E-selectin、肌酸激酶同工酶（creatine kinase isoenzyme MB,CK-MB）、肌钙蛋白Ⅰ（cardiac troponin I,c TnⅠ）、白细胞介素6（interleukin-6,IL-6）、肿瘤坏死因子α（tumor necrosis factor alpha,TNF-α）表达水平,绘制ROC曲线,分析并评价E-选择素在MPP患儿心肌损伤中的诊断价值。结果心肌损伤组和对照组的ES水平分别为（42.26±4.80）、（12.45±3.27）ng/ml;CK-MB分别为（26.63±4.25）、（9.45±4.74）IU/L;c TnⅠ分别为（0.12±0.03）、（0.02±0.01）μg/L;两组间差异均有统计学意义（P均〈0.001）。2组IL-6分别为（20.25±6.12）、（17.32±4.05）pg/ml;TNF-α分别为（26.19±9.75）、（22.31±7.26）pg/ml,两组间差异均无统计学意义（P均〉0.05）。ROC曲线分析显示ES诊断心肌损害的下面积（AUC）为0.945,95%CI为0.899～0.991,敏感性、特异性和约登指数分别为0.801、1.000和0.801,诊断界值为29.67 ng/ml,阳性似然比（Positive LR）为72.5。结论 E-选择素对小儿MPP心肌损伤可能具有较大的诊断价值,与心肌肌酸激酶同工酶及心肌肌钙蛋白等联合可提高心肌损伤诊断的准确性,减少误诊率。

Objective To explore the value of E-selectin in diagnosis of myocardial damage in children with Mycoplasma pneumoniae pneumonia（ MPP）. Methods A prospective,double-blinded,and continuous recruitment study was conducted to detect the expression levels of E- selectin,creatine kinase isoenzyme MB（ CK- MB）,cardiac troponin I（ c Tn Ⅰ）,interleukin- 6（ IL- 6）,tumor necrosis factor-α（ TNF-α） in 36 patients with MPP combined with myocardial damage（ myocardial damage group） and 90 patients with MPP（ control group）. Receiver operating characteristic（ ROC） curve was drawn,the value of E-selectin in diagnosis of myocardial damage in MPP children was analyzed and evaluated. Results The levels of E- selectin in myocardial damage group and control group were（ 42. 26 ±4. 80） ng / ml and（ 12. 45±3. 27） ng / ml,respectively; the levels of CK-MB were（ 26. 63±4. 25） IU / L and（ 9. 45±4. 74） IU / L,respectively; the levels of c TnⅠ were（ 0. 12±0. 03） μg / L and（ 0. 02 ±0. 01） μg / L,respectively,there were statistically significant differences between the two groups（ P0. 001）. The levels of IL-6 in the two groups were（ 20. 25±6. 12） pg / ml and（ 17. 32±4. 05） pg / ml,respectively; the levels of TNF-α were（ 26. 19±9. 75） pg / ml and（ 22. 31±7. 26） pg / ml,respectively,there was no statistically significant difference between the two groups（ P0. 05）. ROC curve analysis showed that the area under ROC curve of E-selectin in diagnosis of myocardial damage was 0. 945,95% CI was 0. 899-0. 991,the sensitivity,specificity,Youden index,cutoff value,and positive likelihood ratio were0. 801,1. 000,0. 801,29. 67 ng / ml,and 72. 5. Conclusion E-selectin is valuable in diagnosis of myocardial damage in MPP children,which can improve the accuracy of diagnosis of myocardial damage and reduce misdiagnosis rate combining with CK-MB,c TnⅠ and other indexes.