重症肺炎患儿血清VEGF、ET-1、CK-MB变化及与心肌损害的关系

Changes of serum VEGF,ET-1 and CK-MB in children with severe pneumonia and their relationship with myocardial damage

目的探讨重症肺炎患儿血清血管内皮生长因子(VEGF)、内皮素1(ET-1)、磷酸肌酸激酶同工酶(CK-MB)水平变化及其与心肌损害的关系。方法选取2017年12月至2018年6月本院收治的重症肺炎患儿68例为重症肺炎组,根据是否发生心肌损害分为心肌损害组(21例)与非心肌损害组(47例),以同期本院诊治的普通肺炎患儿50例为普通肺炎组,另以42例健康儿童为对照组。采用酶联免疫吸附法(ELISA)检测血清VEGF、ET-1水平;全自动生化分析仪检测CK-MB、肌钙蛋白Ⅰ(cTnI)水平;采用比色法检测超氧化物歧化酶(SOD)、丙二醛(MDA)、N-末端脑钠肽前体(NT-proBNP)水平;采用免疫比浊法检测C反应蛋白(CRP)水平。采用Pearson法分析重症肺炎患儿血清VEGF、ET-1、CK-MB水平与心肌损害指标(cTnI、SOD、MDA、NT-proBNP、CRP)相关性;受试者工作特征曲线(ROC)分析VEGF、ET-1、CK-MB对重症肺炎患儿心肌损害的预测价值。结果普通肺炎组与重症肺炎组血清VEGF、ET-1、CK-MB水平均显著高于对照组(P<0.05),且重症肺炎组显著高于普通肺炎组(P<0.05);心肌损害组患儿血清VEGF、ET-1、CK-MB、MDA、CRP、cTnI、NT-proBNP水平均显著高于非心肌损害组(P<0.05),而SOD水平显著降低(P<0.05);Pearson法显示VEGF、ET-1、CK-MB均与SOD呈显著负相关(P<0.05),而均与cTnI、NT-proBNP均呈显著正相关(P<0.05);ROC分析显示VEGF、ET-1、CK-MB的AUC面积分别为0.832、0.786、0.876,敏感性分别为76.19%、85.71%、80.95%,特异性分别为78.72%、65.96%、91.49%,截断值分别为4.98ng/mL、1.86ng/mL、47.44μ/L。结论重症肺炎患儿血清VEGF、ET-1、CK-MB水平明显升高,并与心肌损害指标密切相关,可作为重症肺炎患儿疾病进展及判定心肌损害的重要辅助指标。

Objective To investigate the changes of serum levels of vascular endothelial growth factor (VEGF),endothelin-1 (ET-1),reatine phosphokinase-isoenzyme-MB (CK-MB) and their relationship with myocardial damage in children with severe pneumonia.Methods 68 children with severe pneumonia admitted to our hospital from December 2017 to June 2018 were selected as the severe pneumonia group.According to whether myocardial damage occurred,they were divided into the myocardial damage group (21 cases) and the non-myocardial damage group (47 cases).50 children with common pneumonia diagnosed and treated in our hospital during the same period were taken as the common pneumonia group,and 42 healthy children as the control group.Serum levels of VEGF and ET-1 were detected by enzyme-linked immunosorbent assay (ELISA);CK-MB and troponin I were detected by automatic biochemical analyzer,superoxide dismutase (SOD),malondialdehyde (MDA) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were detected by colorimetry,and C-reaction was detected by immunoturbidimetry. Protein (CRP) level.The predictive value of vascular endothelial growth factor,ET-1 and CK-MB on myocardial damage in children with severe pneumonia was analyzed by ROC.Results The serum levels of VEGF,ET-1 and CK-MB in the common pneumonia group and the severe pneumonia group were significantly higher than those in the control group ( P< 0.05),and they were significantly higher in the severe pneumonia group than in the common pneumonia group ( P< 0.05).The serum levels of vascular endothelial growth factor,ET-1,CK-MB,MDA,CRP,cTnI and NT-proBNP in the myocardial damage group were significantly higher than those in the non-myocardial damage group ( P< 0.05),while the level of SOD was significantly lower ( P< 0.05).Pearson method showed that the levels of VEGF,ET-1 and CK-MB were negatively correlated with SOD ( P< 0.05),but positively correlated with cTnI and NT-proBNP ( P< 0.05).ROC analysis showed that the AUC areas of VEGF,ET-1 and CK-MB were 0.832,0.786 and 0.876,respectively.The sensitivity was 76.19%,85.71% and 80.95%,the specificity was 78.72%,65.96% and 91.49%,and the cutoff values were 4.98 ng/mL,1.86 ng/mL and 47.44 u/L,respectively.Conclusion The serum levels of VEGF,ET-1 and CK-MB in children with severe pneumonia are significantly increased,which are closely related to the index of myocardial damage,and they can be used as important auxiliary indexes for disease progression and judgment of myocardial damage in children with severe pneumonia.