柯萨奇病毒感染相关病毒性心肌炎外周血CD80和CD86表达及意义

Expression of CD80 and CD86 in peripheral blood of patients with Coxsackie virus infection-induced viral myocarditis and their significance

目的探讨柯萨奇病毒(CBV)感染相关病毒性心肌炎(VMC)外周血CD80、CD86水平变化与临床价值。方法选择2018年2月-2020年6月天津医科大学第二附属医院心内科收治的CBV感染VMC患者76例为研究对象,根据病情严重程度分为重症组25例和轻症组51例,根据患者14 d预后分为存活组59例和死亡组17例。患者均在入院当天检测心功能指标:包括肌酸激酶(CK)、肌钙蛋白T(cTnT)和肌钙蛋白I(cTnI),血常规指标:C-反应蛋白(CRP)、中性粒细胞/淋巴细胞比值(NLR),检测左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)和心脏每搏输出量(SV);流式细胞仪检测患者外周血淋巴细胞CD80、CD86水平。结果重症组CK、cTnT、cTnI、CRP、NLR、CD_(19)^(+)CD_(80)^(+)水平高于轻症组,LVEF、SV、CD_(19)^(+)CD_(86)^(+)水平低于轻症组,差异均具有统计学意义(P<0.05),两组LVEDD水平比较,无统计学差异;死亡组CK、cTnT、cTnI、CRP、NLR、CD_(19)^(+)CD_(80)^(+)水平高于存活组,LVEF、SV、CD_(19)^(+)CD_(86)^(+)水平低于存活组,差异均具有统计学意义(P<0.05),两组LVEDD水平比较,无统计学差异;受试者工作特征曲线(ROC)分析结果显示,入院时基线CD_(19)^(+)CD_(80)^(+)、CD_(19)^(+)CD_(86)^(+)水平用于患者预后预测,其曲线下面积分别为0.788和0.751,标准误分别为0.048和0.052,95%CI为0.694~0.882和0.649~0.853,两指标联合时曲线下面积为0.802,标准误为0.047,95%CI为0.710~0.893,均具有统计学意义(P<0.05)。结论外周血B细胞中CD80、CD86水平变化可反映CBV感染所致VMC的严重程度,对于患者预后有一定预测价值。

OBJECTIVE To explore the changes of peripheral blood CD80 and CD86 levels of patients with Coxsackie B virus(CBV)infection-induced viral myocarditis(VMC)and analyze the clinical values.METHODS A total of 76 patients with CBV infection-induced VMC who were treated in department of cardiology of Second Affiliated Hospital of Tianjin Medical University from Feb 2018 to Jun 2020 were recruited as the study objects and were divided into the severe group with 25 cases and the mild group with 51 cases according to the illness condition,the patients were divided into the survival group with 59 cases and the death group with 17 cases according to the 14-day prognosis.The cardiac function indexes,including creatine kinase(CK),troponin T(cTnT)and troponin I(cTnI)and the blood routine indexes:C-reactive protein(CRP),neutrophil/lymphocyte ratio(NLR)were detected on the day of admission;the left ventricle ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)and heart stroke volume(SV)were detected;the levels of peripheral blood lymphocytes CD80 and CD86 were detected by using flow cytometry.RESULTS The levels of CK,cTnT,cTnI,CRP,NLR and CD_(19)^(+)CD_(80)^(+) of the severe group were significantly higher than those of the mild group;the levels of LVEF,SV and CD_(19)^(+)CD_(86)^(+) of the severe group were significantly lower than those of the mild group(P<0.05);there was no significant difference in the LVEDD level between the two groups.The levels of CK,cTnT,cTnI,CRP,NLR and CD_(19)^(+)CD_(80)^(+) of the death group were significantly higher than those of the survival group;the levels of LVEF,SV and CD_(19)^(+)CD_(86)^(+) of the death group were significantly lower than those of the survival group(P<0.05);there was no significant difference in the LVEDD level between the two groups.Receiver operating characteristic(ROC)curve analysis showed that the areas under curves(AUCs)of the baseline CD_(19)^(+)CD_(80)^(+) and CD_(19)^(+)CD_(86)^(+) levels at the admission were respectively 0.788 and 0.751 in prediction of prognosis,the standard errors were 0.048 and 0.052,respectively,and the 95%CI were 0.694-0.882 and 0.649-0.853,respectively;the area under curve of the joint detection of the two indexes was 0.802,the standard error 0.047,the 95%CI 0.710-0.893,and there was significant difference(P<0.05).CONCLUSION The CD80 and CD86 in peripheral blood B cells may reflect the severity of CBV infection-induced VMC and have certain value in prediction of prognosis.