心力衰竭合并肺部感染患儿基质金属蛋白酶变化及与心肌功能的关系

Correlation between changes of matrix metalloproteinases of heart failure children complicated with pulmonary infection and myocardial function

目的探讨心力衰竭合并肺部感染患儿基质金属蛋白酶(MMPs)、中性粒细胞CD64、白细胞介素-17(IL-17)、白细胞介素-21(IL-21)水平变化及与心肌功能的关系。方法选取2016年1月-2018年8月于天津市儿童医院进行治疗的心力衰竭合并肺部感染患儿148例为感染组。选择同期于医院进行治疗的150例心力衰竭未合并肺部感染患儿为非感染组。比较两组MMPs、心肌酶谱及其他血清因子水平变化。同时比较感染组MMPs、CD64、IL-17、IL-21与心肌功能的关系。结果感染组MMP-2、MMP-9以及MMP-10,IL-17、TNF-α水平均高于非感染组,且两组间差异显著(P<0.001)。感染组CK、AST、CKMB以及LDH水平,CD64、PCT水平均高于非感染组,且两组间差异显著(P<0.001)。感染组NYHA-Ⅰ级和Ⅱ级的MMP-2、MMP-9、MMP-10、CD64以及IL-17水平均低于NYHA-Ⅲ级和Ⅳ级(P<0.05或P<0.001),IL-21水平两组间比较无统计学差异。结论MMPs、CD64、IL-17、IL-21水平在心力衰竭合并肺部感染患儿中变化灵敏,能够反映机体心肌功能以及肺部感染程度,对指导病情具有一定的临床价值。

OBJECTIVE To explore the correlation between the changes of matrix metalloproteinases(MMPs),neutrophil CD64,interleukin-17(IL-17)and interleukin-21(IL-21)and the myocardial function of the heart failure children with pulmonary infection.METHODS Totally 148 heart failure children who were complicated with pulmonary infection and treated in Tianjin Children’s Hospital from Jan 2016 to Aug 2018 were chosen as the infection group,meanwhile,150 heart failure children who were not complicated with pulmonary infection were assigned as the non-infection group.The levels of MMPs,myocardial enzymes and other serological factors were compared between the two groups,and the correlation between the MMPs,CD64,IL-17,IL-21 of the patients in the infection group and the myocardial function was observed.RESULTS The levels of MMP-2,MMP-9,MMP-10,IL-7 and TNF-αof the infection group were significantly higher than those of the non-infection group(P<0.001).The levels of CK,AST,CKMB,LDH,CD64 and PCT of the infection group were significantly higher than those of the non-infection group(P<0.001).In the infection group,the levels of MMP-2,MMP-9,MMP-10,CD64 and IL-17 of the patients with grade NYHA-ⅠandⅡwere significantly lower than those of the patients with grade NYHA-ⅢandⅣ(P<0.05 or P<0.001).There was no significant difference in the IL-21 level between the two groups.CONCLUSION The sensitive changes of MMPs,CD64,IL-17 and IL-21 may reflect the myocardial function and severity of pulmonary infection in the heart failure children complicated with pulmonary infection,which have certain clinical value in prediction of illness condition.