血清SAA及PTX-3和肌钙蛋白在儿童病毒性心肌炎诊断及预后评估中的价值

Values of serum SAA,PTX-3 and troponin in diagnosis of viral myocarditis in children and assessment of prognosis

目的 探讨血清淀粉样蛋白A (SAA)、正五聚体蛋白-3(PTX-3)及肌钙蛋白(cTnI)在儿童病毒性心肌炎(VMC)诊断及预后评估中的价值。方法 选取2012年10月-2020年12月济宁医学院附属医院收治的VMC患儿82例为VMC组,另选取同期健康体检儿童40名为对照组,分析血清SAA、PTX-3及cTnI水平对VMC诊断及预后评估中的价值。结果 82例患儿共分离出病毒83株,其中柯萨奇病毒占比高于其他病毒株;VMC组血清SAA、PTX-3、cTnI水平高于对照组(P<0.05);血清SAA、PTX-3、cTnI水平联合检测诊断VMC的受试者工作特征曲线下面积(AUC)为0.948,灵敏度为90.24%,特异度为95.00%;血清SAA、PTX-3、cTnI水平随VMC患儿心衰程度加重而升高(P<0.05);预后不良组血清SAA、PTX-3、cTnI水平高于预后良好组(P<0.05);血清SAA、PTX-3、cTnI水平联合检测评估VMC患儿预后不良的AUC为0.856,灵敏度为91.67%,特异度为65.52%。结论 VMC患儿血清SAA、PTX-3、cTnI水平升高,且其升高水平与患儿心衰程度有关,在一定程度上三项指标可用于辅助VMC患儿的早期诊断和预后评估。

OBJECTIVE To explore the values of serum amyloid A(SAA),pentraxin-3(PTX-3) and cardiac troponin I(cTnI) in diagnosis of viral myocarditis(VMC) in children and assessment of prognosis.METHODS A total of 82 children with VMC who were treated in the Affiliated Hospital of Jining Medical University from Oct 2012 to Dec 2020 were assigned as the VMC group,meanwhile,40 healthy children who received physical examination were chosen as the control group.The values of serum SAA,PTX-3 and cTnI in diagnosis of VMC and assessment of prognosis were analyzed.RESULTS Totally 83 strains of viruses were isolated from 82 children,the percentage of Coxsackie virus was significantly higher than that of other species.The levels of serum SAA,PTX-3 and cTnI of the VMC group were significantly higher than those of the control group(P<0.05).The area under curve(AUC) of the joint detection of serum SAA,PTX-3 and cTnI was 0.948 in diagnosis of VMC,with the sensitivity 90.24%,the specificity 95.00%.The levels of serum SAA,PTX-3 and cTnI of the children with VMC were significantly elevated with the aggravation of heart failure(P<0.05).The levels of serum SAA,PTX-3 and cTnI of the poor prognosis group were significantly higher than those of the favorable prognosis group(P<0.05).The AUC of the joint detection of serum SAA,PTX-3 and cTnI was 0.856 in assessment of poor prognosis of the children with VMC,with the sensitivity 91.67%,the specificity 65.52%.CONCLUSION The levels of serum SAA,PTX-3 and cTnI of the children with VMC are elevated,which are associated with the severity of heart failure and may facilitate early diagnosis of VMC and assessment of prognosis.