淋巴细胞亚群对病毒性心肌炎患者生存率的预测价值

Predictive Value of Lymphocyte Subpopulation on Evaluation of Long-term Survival in Patients with Viral Myocarditis

目的:分析淋巴细胞亚群对病毒性心肌炎患者远期生存率的预测价值。方法:分析2012年5月-2014年5月67例病毒性心肌炎患者临床资料。绘制受试者工作特征曲线(ROC)分析多种指标对病毒性心肌炎患者远期生存率的预测价值。结果:死亡组IL-6、C反应蛋白、CD4^(+)/CD8^(+)比例均显著高于存活组(P<0.05)。死亡组淋巴细胞数、CD8^(+)比例均显著低于存活组(P<0.05)。APACHEⅡ、CK-MB、淋巴细胞计数、CD4^(+)/CD8^(+)比例、CD8^(+)比例的ROC曲线下面积分别为0.819[95%CI(0.734,0.904)]、0.844[95%CI(0.764,0.924)]、0.896[95%CI(0.821,0.971)]、0.879[95%CI(0.802,0.956)]、0.940[95%CI(0.876,1.000)]。当CD8^(+)比例取临界值为15.5%时,敏感度和特异度分别为93.3%和85.7%。当淋巴细胞数取临界值为0.63×10^(9)/L时,敏感度和特异度分别为93.3%和82.1%。CD8^(+)比例和淋巴细胞数分别取15.5%和0.63×10^(9)/L为最佳临界值时,平行试验敏感度和特异度分别为99.6%和70.4%,约登指数为0.74;序列试验敏感度和特异度分别为87.0%和97.4%,约登指数为0.84,序列试验的诊断效能优于平行试验。与死亡相关的危险因素为CK-MB(OR=1.215,P=0.01)、CD8^(+)比例(OR=0.24,P<0.01)。结论:CD8^(+)比例和淋巴细胞数可用于预测病毒性心肌炎患者远期生存率。当CD8^(+)比例和淋巴细胞数分别取15.5%和0.63×10^(9)/L为最佳临界值时,序列试验优于平行试验,CK-MB和CD8^(+)比例是病毒性心肌炎患者死亡的独立危险因素。

Objective： To investigate predictive value of lymphocyte subpopulation on evaluation of long- term survival in patients with viral myocarditis.Method： A total of 67 patients with viral myocarditis were enrolled from May 2012 to May 2014 prospectively.ROC curve was done to analyze predictive value of indicators on long-term survival in these patients.Result： IL-6, CRP, CD4＋/CD8＋ ratio of the death group were significantly higher than those of the survival group （ P〈0.05 ） .Lymphocyte count and CD8＋ ratio of the death group were significantly lower than those of the survival group （ P〈0.05 ） .Aera under ROC of APACHEII, CK-MB, lymphocyte count,CD4＋/CD8＋ ratio and CD8＋ ratio were 0.819195%CI （ 0.734, 0.904 ） ], 0.844195%CI （ 0.764, 0.924 ） ], 0.896195%CI （ 0.821, 0.971 ） ], 0.879195%CI （ 0.802, 0.956 ） ], 0.940195%CI （ 0.876, 1.000 ） ].When the optimal cutoff value of CD8＋ ratio was 15.5%, sensitivity and specificity were respectively 93.3% and 85.7%.When the optimal cutoff value of lymphocyte count was 0.63 × 10^9/L, sensitivity and specificity were respectively 93.3% and 82.1%.Tbe efficacy of serial test （ sensitivity： 87.0%, specificity： 97.4%, Yuden Index： 0.84 ） was better than that of parallel test （ sensitivity： 99.6%, specificity： 70.4%, Yuden Index： 0.74 ） .CK-MB （ OR=1.215, P=0.01 ） and CD8＋ ratio （ OR=0.24, P〈0.01 ） were the death cause and risk factors of viral myoearditis.Conelusion： CD8＋ ratio and lymphocyte count could be helpful to predicting long-term survival rate in patients with viral myocarditis.When the optimal cutoff value of CD8＋ ratio and lymphocyte count are 15.5% and 0.63 × 10^9/L.The efficacy of serial test is better than that of parallel test.CK-MB and CD8＋ ratio are the death cause and risk factors of viral myocarditis.