肺炎合并心力衰竭患儿血清生化因子水平的变化

Changes of serum biochemical factors levels in children with pneumonia complicated with heart failure

目的探讨肺炎合并心力衰竭患儿血清生化因子[胰岛素样生长因子1(IGF-1)、D-二聚体、心肌肌钙蛋白I(c Tn I)和心型脂肪酸结合蛋白(H-FABP)]水平的变化情况。方法选取2016年1月至2019年11月河北省儿童医院及南皮县人民医院收治的肺炎患儿187例,其中合并心力衰竭者106例(肺炎合并心力衰竭组),未合并心力衰竭者81例(肺炎组),另选取同期于两所医院经体格检查的健康儿童92名作为健康对照组,比较3组研究对象血清IGF-1、D-二聚体、H-FABP、c Tn I水平以及心功能指标左心室短轴缩短率(LVFS)和左心室射血分数(LVEF)水平,分析肺炎合并心力衰竭患儿血清生化因子与心功能指标水平的相关性。结果肺炎合并心力衰竭组患儿血清IGF-1水平低于肺炎组和健康对照组[(41±10)μg/L比(80±9)、(104±17)μg/L],且肺炎组低于健康对照组;血清D-二聚体、c Tn I、H-FABP水平均高于肺炎组和健康对照组[(0.59±0.12) mg/L比(0.39±0.06)、(0.28±0.04) mg/L,(0.732±0.192)μg/L比(0.371±0.082)、(0.131±0.021)μg/L,(18.74±4.04)μg/L比(2.96±0.49)、(1.75±0.26)μg/L],且肺炎组均高于健康对照组,差异均有统计学意义(均P <0.05)。肺炎合并心力衰竭组LVFS、LVEF水平均低于肺炎组和健康对照组,差异均有统计学意义(均P <0.05)。肺炎合并心力衰竭组血清IGF-1水平与LVFS、LVEF均呈正相关(r=0.737、0.705,均P <0.001),血清D-二聚体、c Tn I、H-FABP水平与LVFS(r=-0.571、-0.602、-0.642,均P <0.001)和LVEF(r=-0.546、-0.564、-0.641,均P <0.001)均呈负相关。结论肺炎合并心力衰竭患儿血清IGF-1呈相对低表达,D-二聚体、c Tn I、H-FABP呈相对高表达,这些因子可能参与了肺炎患儿心力衰竭的发生与发展。

Objective To investigate the changes of serum levels of insulin-like growth factor 1(IGF-1),D-dimer,cardiac troponin I(cTnI)and cardiac fatty acid binding protein(H-FABP)in children with pneumonia complicated with heart failure.Methods From January 2016 to November 2019,187 children with pneumonia admitted to Hebei Children’s Hospital and Nanpi People’s Hospital were selected,including 106 cases complicated with heart failure(pneumonia complicated with heart failure group)and 81 cases without heart failure(pneumonia group),92 healthy children with physical examination at same period were selected as the healthy control group.Serum IGF-1,D-dimer,cTnI,and H-FABP levels were measured in three groups,and serum IGF-1,D-dimer,cTnI,and H-FABP levels and cardiac function indexes including left ventricular fractional shortening(LVFS)and left ventricular ejection fraction(LVEF)were compared among the three groups.Correlation among serum biochemical factors and cardiac function indexes was analyzed.Results The level of serum IGF-1 in pneumonia complicated with heart failure group was lower than that in pneumonia group and healthy control group[(41±10)μg/L vs(80±9),(104±17)μg/L],which in pneumonia group was lower than that in healthy control group;the levels of serum D-dimer,c Tn I and H-FABP in pneumonia complicated with heart failure group were higher than those in pneumonia group and healthy control group[(0.59±0.12)mg/L vs(0.39±0.06),(0.28±0.04)mg/L,(0.732±0.192)μg/L vs(0.371±0.082),(0.131±0.021)μg/L,(18.74±4.04)μg/L vs(2.96±0.49),(1.75±0.26)μg/L],which in pneumonia group were higher than those in healthy control group,the differences were statistically significant(all P<0.05).The levels of LVFS and LVEF in pneumonia complicated with heart failure group were lower than those in pneumonia group and healthy control group(all P<0.05).Pearson correlation analysis showed that IGF-1 level was positively correlated with LVFS and LVEF(r=0.737,0.705,both P<0.001);serum D-dimer,c Tn I and H-FABP were negatively correlated with LVFS(r=-0.571,-0.602,-0.642,all P<0.001),and LVEF(r=-0.546,-0.564,-0.641,all P<0.001).Conclusions Serum IGF-1 was relatively low in expression,while D-dimer,c Tn I and H-FABP were relatively high in expression in children with pneumonia complicated with heart failure.These factors may be involved in the occurrence and development of heart failure in children with pneumonia.