成人暴发性心肌炎患者血清一氧化氮水平的变化及临床意义

The change of serum nitric oxide level in adult patients with fulminant myocarditis and its clinical significance

目的研究血清一氧化氮(NO)水平与成人暴发性心肌炎患者淋巴细胞紊乱及院内死亡的关系。方法选择2019年3月至2021年12月期间上海市同济大学医学院收治的成人暴发性心肌炎患者作为研究对象,根据是否发生院内死亡分为存活组(n=57)和死亡组(n=20)。比较两组患者血清NO水平、NT⁃proBNP峰值、心肌肌钙蛋白I(cTnI)峰值、肿瘤坏死因子⁃α(TNF⁃α)、白介素⁃6(IL⁃6)、细胞间黏附分子⁃1(ICAM⁃1)及外周血CD4^(+)%、CD8^(+)%、CD4^(+)/CD8^(+)的差异,采用Pearson检验分析不同指标间的相关性,采用ROC曲线分析NO对院内死亡的预测价值。结果死亡组患者的血清NO水平及NT⁃proBNP、cTnI峰值均高于存活组,差异有统计学意义(t=6.034、8.405、14.635,P均<0.05);血清NO水平与NT⁃proBNP峰值及cTnI峰值均呈正相关(r=0.361、-0.441,P均<0.05);死亡组患者外周血CD4^(+)%,CD4^(+)/CD8^(+)均高于存活组,CD8+%低于存活组,差异有统计学意义(t=2.065、9.769、5.825,P<0.05);死亡组患者的血清TNF⁃α、IL⁃6、ICAM⁃1含量均高于存活组,差异有统计学意义(t=10.984、10.848、8.837,P<0.05);成人暴发性心肌炎患者血清NO水平、NT⁃proBNP峰值、cTnI峰值与CD4^(+)%,CD4^(+)/CD8^(+)及TNF⁃α、IL⁃6、ICAM⁃1含量均呈正相关,与CD8^(+)%呈负相关;血清NO水平对院内死亡具有预测价值,预测的最佳截断值为30.10μmol/L(灵敏度78.95%、特异性80.00%)。结论成人暴发性心肌炎患者血清NO水平升高与淋巴细胞紊乱、细胞因子释放增加及院内死亡有关。

Objective To study the relationship between serum nitric oxide(NO)level and lymphocyte disorder,hospital death in adult patients with fulminant myocarditis.Methods Adult patients with fulminant myocarditis treated in Shanghai Tongji University School of Medicine from March 2019 to December 2021 were selected as the research object.They were divided into the survival group(n=57)and the death group(n=20)according to whether there was in⁃hospital death.The serum NO level,NT proBNP peak,cardiac troponin I(cTnI)peak and the contents of tumor necrosis factor⁃α(TNF⁃α),interleukin⁃6(IL⁃6),intercellular adhesion molecule⁃1(ICAM⁃1)and CD4^(+)%,CD8+%and CD4^(+)/CD8^(+)in peripheral blood were compared between the two groups.The correlation between different indexes was analyzed by Pearson test,and the predictive value of NO on hospital death was analyzed by ROC curve.Results The serum NO level and the peak value of NT⁃proBNP and cTnI in the death group were higher than those in the survival group,and the difference was statistically significant(t=6.034,8.405,14.635,P<0.05).The serum NO level was positively correlated with the peak value of NT⁃proBNP and cTnI(r=0.361,-0.441,P<0.05).The peripheral blood CD4^(+)%and CD4^(+)/CD8^(+)of the death group were higher than those of the survival group,and CD8^(+)%was lower than that of the survival group,and the differences were statistically significant(t=2.065,9.769,5.825,P<0.05).The serum levels of TNF⁃α,IL⁃6 and ICAM⁃1 in the death group were higher than those in the survival group,and the difference was statistically significant(t=10.984,10.848,8.837,P<0.05).Serum NO level,NT⁃proBNP peak value and cTnI peak value in adult patients with fulminant myocarditis were positively correlated with CD4^(+)%,CD4^(+)/CD8^(+)and TNF⁃α,IL⁃6,ICAM⁃1 content,and negatively correlated with CD8+%.Serum NO level has predictive value for in⁃hospital death,and the best cut⁃off value for prediction is 30.10μmol/L(sensitivity 78.95%,specificity 80.00%).Conclusion The increase of serum NO level in adult patients with fulminant myocarditis is related to lymphocyte disorder,increased cytokine release and in⁃hospital death.