病毒性心肌炎患者血清Gal-3、PTX-3表达及其预后意义

Expressions and prognostic significances of serum Gal-3 and PTX-3 in patients with viral myocarditis

目的:探讨病毒性心肌炎患者血清半乳糖凝集素-3(galectin-3,Gal-3)、正五聚体蛋白-3(pentraxin-3,PTX-3)表达水平及其诊断及预后评估价值。方法:选取2018年1月—2019年7月本院收治的122例病毒性心肌炎患者为研究对象(心肌炎组),同期选取118例健康体检者作为对照组。采用酶联免疫吸附法检测血清Gal-3、PTX-3及心肌指标脑钠肽(brain natriuretic peptide,BNP)、肌酸激酶同工酶(creatine kinase MB,CK-MB)、心肌肌钙蛋白I(cardiac troponin I,cTnI)水平;采用Pearson法分析病毒性心肌炎患者血清Gal-3、PTX-3与心肌指标的相关性;采用受试者工作特征曲线(receiver operator charateristic curve,ROC曲线)分析血清Gal-3、PTX-3水平对病毒性心肌炎的诊断价值;采用多因素Logistic回归分析影响病毒性心肌炎患者预后的因素。结果:心肌炎组血清Gal-3、PTX-3、BNP、CK-MB、cTnI水平高于对照组,差异有统计学意义(P>0.05)。病毒性心肌炎患者血清Gal-3与PTX-3呈正相关(r=0.594、P<0.05),且二者与BNP、CK-MB、cTnI均呈正相关(P<0.05)。血清Gal-3、PTX-3水平诊断病毒性心肌炎的曲线下面积(area under curve,AUC)分别为0.873、0.916,截断值分别为5.431 ng/mL、4.159 ng/mL,特异性分别为74.5%、84.7%,敏感度分别为84.4%、82.0%;二者联合诊断的AUC为0.969,特异性为95.9%,敏感度为88.5%。预后不良组病毒性心肌炎患者血清Gal-3、PTX-3水平高于预后良好组,差异有统计学意义(P<0.05)。Gal-3、PTX-3、cTnI是影响病毒性心肌炎患者预后不良的独立危险因素(P<0.05)。结论:病毒性心肌炎患者血清Gal-3、PTX-3表达水平升高,二者对病毒性心肌炎诊断及预后评价均可能有重要价值。

Objective To investigate the levels of serum galectin-3(Gal-3)and pentameric protein-3(PTX-3)in patients with viral myocarditis and the diagnostic and prognostic values.Methods A total of 122 patients with viral myocarditis in our hospital from January 2018 to July 2019 were selected as the research subjects(myocarditis group)while 118 healthy subjects within the same period were selected as control group.The levels of serum Gal-3,PTX-3,brain natriuretic peptide(BNP),creatine kinase isoenzyme(CK-MB)and cardiac troponin I(cTnI)were detected by enzyme-linked immunosorbent assay(ELISA).Pearson method was used to analyze the correlation between serum Gal-3,Ptx-3 and myocardial indexes in patients with viral myocarditis.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of serum Gal-3 and Ptx-3 levels for viral myocarditis.Multivariate logistic regression analysis was used to analyze the prognostic factors of patients with viral myocarditis.Results The levels of serum Gal-3,PTX-3,BNP,CK-MB and cTnI in myocarditis group were significantly higher than those in control group(P<0.05).Serum Gal-3 was positively correlated with PTX-3(r=0.594,P<0.05).Both Gal-3 and PTX-3 were positively correlated with BNP,CK-MB and cTnI(P<0.05).The areas under the curve(AUCs)of serum Gal-3 and PTX-3 levels in the diagnosis of viral myocarditis were 0.873 and 0.916 with the cut-off values of 5.431 ng/mL and 4.159 ng/mL,respectively.The specificity were 74.5%and 84.7%,and the sensitivity were 84.4%and 82.0%,respectively.The AUC of the combined diagnosis by both criteria was 0.969 with the specificity of 95.9%and the sensitivity of 88.5%.The levels of serum Gal-3 and PTX-3 in the poor prognosis group were higher than those in the good prognosis group(P<0.05).Gal-3,PTX-3 and cTnI were independent risk factors of poor prognosis in patients with viral myocarditis(P<0.05).Conclusions The expression levels of serum Gal-3 and PTX-3 increased in patients with viral myocarditis.Both criteria may have important values in the diagnosis and prognosis evaluation of viral myocarditis.