血清miR-31、IL-22联合检测在儿童病毒性心肌炎诊断及预后评估中的价值

Value of combined detection of serum miR⁃31 and IL⁃22 in diagnosis and prognosis assessment of viral myocarditis in children

目的 研究血清微小RNA-31(miR-31)、白细胞介素-22(IL-22)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2017年1月至2022年1月河南省儿童医院心血管内科收治的病毒性心肌炎患儿作为研究对象,将其命名为VMC组(n=106),另选同期在本院进行体检的健康儿童为对照组(n=70)。比较两组血清miR-31、IL-22、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白T(cTnT)及心电图参数[QRS间期、PR间期]与超声心动图参数[左室射血分数(LVEF)、左心室短轴缩短率(LVFS)];在治疗结束后对VMC患儿随访1年,以随访期间发生恢复迁延、扩张性心肌病、遗留心律失常及患儿死亡等事件为预后不良,根据多因素Logistic回归分析VMC患儿预后不良的影响因素,并绘制ROC曲线分析血清miR-31、IL-22水平对VMC患儿诊断及预后不良评估的价值。结果 VMC组的血清miR-31、IL-22、CK-MB、cTnT水平及QRS间期、PR间期均高于对照组,差异有统计学意义(P<0.05),LVEF、LVFS均低于对照组,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,miR-31水平高表达、IL-22水平升高、CK-MB水平升高、cTnT水平升高、QRS间期延长、PR间期延长、LVEF降低及LVFS降低均是VMC患儿预后不良的独立危险因素(P<0.05);ROC曲线分析显示,血清miR-31、IL-22水平二者联合检测诊断VMC的曲线下面积(AUC)为0.990,优于单一检测(P<0.05);血清miR-31、IL-22水平二者联合检测评估VMC患儿预后不良的曲线下面积(AUC)为0.919,优于单一检测(P<0.05)。结论 miR-31、IL-22在病毒性心肌炎患儿血清中高表达,可能成为儿童病毒性心肌炎诊断及预后评估的辅助诊断指标。

Objective To study the value of serum microRNA-31(miR-31)and interleukin-22(IL-22)in the diagnosis and prognosis of viral myocarditis in children.Methods Children with viral myocar-ditis(VMC)who were admitted to the Cardiovascular Department of Henan Childrens Hospital from January 2017 to January 2022 were selected as the study subjects and referred to as the VMC group(n=106).Healthy children who underwent physical examinations in the hospital during the same period were selected as the con-trol group(n=70).Serum levels of miR-31,IL-22,creatine kinase isoenzyme(CK-MB),cardiac troponin T(cTnT),ECG parameters[QRS interval,PR interval]and echocardiographic parameters[left ventricular ejection fraction(LVEF),left ventricular short axis shortening rate(LVFS)]were compared between the two groups.Patients with VMC were followed up for 1 year after the completion of treatment.Poor prognosis events such as delayed recovery,dilated cardiomyopathy,residual arrhythmia and child death were considered durinh the follow-up period.The influencing factors of poor prognosis in children with VMC were analyzed us-ing multivariate logistic regression.The ROC curve was drawn to analyze the value of serum miR-31 and IL-22 levels in diagnosis and poor prognosis assessment of children with VMC.Results Serum levels of miR-31,IL-22,CK-MB,cTnT,QRS interval and PR interval in the VMC group were higher than those in the control group,with statistical significance(P<0.05).LVEF and LVFS were lower than the control group,and the dif-ference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that high ex-pression of miR-31,elevated IL-22,elevated CK-MB,elevated cTnT,prolonged QRS interval,prolonged PR interval,decreased LVEF and decreased LVFS were independent risk factors for poor prognosis in children with VMC(P<0.05).The ROC curve analysis showed that the area under the curve(AUC)of the combined detection of serum miR-31 and IL-22 levels was 0.990,which was better than that of single detection(P<0.05).The area under the curve(AUC)of the combined detection of serum miR-31 and IL-22 was 0.919,which was better than that of single detection(P<0.05).Conclusion miR-31 and IL-22 are highly expressed in the serum of children with viral myocarditis.This finding suggests that they could serve as auxiliary diagnos-tic indicator for the diagnosis and prognosis evaluation of viral myocarditis in children.