暴发性心肌炎患者降钙素原及细胞因子水平增高

Elevated levels of procalcitonin and cytokines in patients with fulminant myocarditis

目的:分析暴发性心肌炎(FM)患者炎症相关指标白细胞(WBC)计数、降钙素原(PCT)及细胞因子水平变化。方法:连续入选临床诊断FM患者120例,收集实验室炎症相关指标,包括WBC计数及分类、PCT和部分细胞因子水平及其动态变化结果。根据患者出院病情转归情况,将120例FM患者分为非好转组15例与好转组105例,并比较2组血常规、PCT、超敏C反应蛋白(hsCRP)、红细胞沉降率(ESR)及细胞因子水平。结果:①FM患者入院第1天,WBC总数高于正常范围[均值(9.91±0.41)×10^(9)/L],并且中性粒细胞绝对值升高[均值(7.98±0.40)×10^(9)/L];入院后第3和7天,WBC计数较第1天升高(P=0.045、0.013)。②入院第1天,PCT(均值2.92 ng/mL,参考范围<0.05 ng/mL)显著高于正常值,第3天高达18.26 ng/mL,第7天仍为3.02 ng/mL;血中细胞因子水平白介素(IL)-1β、IL-2R、IL-6、IL-8、IL-10和肿瘤坏死因子(TNF)-α水平均显著高于正常范围。③非好转组与好转组比较,仅hsCRP差异有统计学意义(P=0.027)。另外,非好转组细胞因子IL-2R及IL-10高于好转组(P=0.025、0.032)。结论:FM患者细胞因子水平、血浆PCT、外周血WBC及中性粒细胞均显著增高,并与细菌感染无关。

Objective:To analyze the changes of white blood cells(WBCs),procalcitonin(PCT),and cytokines in patients with fulminant myocarditis(FM).Methods:A total of 120 patients with FM were selected consecutively,and laboratory inflammation related tests were collected,including leucocyte count and classification,PCT and some cytokines levels and their dynamic changes.According to the discharge condition of the patients,120 objects were divided into a non-improvement group(n=15)and an improvement group(n=105),and the above indicators were compared between the two groups.Results:On the first day of admission of patients with FM,the total number of WBCs was greater than the normal range[mean(9.91±0.41)×10^(9)/L),and the absolute value of neutrophils increased[mean(7.98±0.40)×10^(9)/L).On the 3rd and 7th days after admission,the leucocyte count increased compared to the 1st day(P=0.045,0.013).On the first day of admission,PCT(mean 2.92 ng/mL,reference range<0.05 ng/mL)was significantly higher than normal,reaching 18.26 ng/mL on the third day,and still reaching 3.02 ng/mL on the 7th day.Blood cytokines including interleukin(IL)-1β,IL-2R,IL-6,IL-8,IL-10 and TNF-αin FM patients were significantly higher than the normal range.There was statistically significant difference in hsCRP between the improvement group and the non-improvement group(P=0.027).In addition,the levels of IL-2R and IL-10 were higher in the non-improvement group than in the improvement group(P=0.025,0.032).Conclusion:In patients with FM,the levels of peripheral blood WBCs,neutrophils,plasma PCT and cytokines are significantly increased,but not related to bacterial infection.