摘要
目的探讨病毒性脑炎(viral encephalitis,VE)合并心肌损害患儿血清Th1/Th2细胞因子含量变化及其诊断效能。方法选取我院VE合并心肌损害患儿102例作为研究组,遵循1∶1分配原则另纳入102例VE、102例健康体检儿童作为VE对照组、正常对照组。统计3组血清Th1细胞因子[干扰素γ(interferon-γ,IFN-γ)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)]及Th2细胞因子[白细胞介素(interleukin,IL)-4、IL-10]、心肌酶谱指标[乳酸脱氢酶(lactate dehydrogenase,LDH)、心肌损伤标志物肌酐蛋白(cardic troponin I,cTnI)、肌酸激酶同工酶(creatine kinase isoenzymes,CK-MB)],比较研究组不同心肌损害程度血清Th1/Th2细胞因子,Spearman分析血清Th1/Th2细胞因子与心肌损伤程度相关性,绘制受试者工作特征曲线(receiver operating characteristic,ROC)、决策曲线(decision curve analysis,DCA)和临床影响曲线(clinical impact curve,CIC)分析血清Th1/Th2细胞因子诊断VE合并心肌损害价值。结果3组血清IFN-γ、TNF-α、CK-MB、cTnI、LDH水平比较:研究组>VE对照组>正常对照组,血清IL-4、IL-10水平比较:研究组<VE对照组<正常对照组(P<0.05);研究组不同心肌损害程度血清IFN-γ、TNF-α水平比较:重度>中度>轻度,血清IL-4、IL-10水平比较:重度<中度<轻度(P<0.05);VE合并心肌损害患儿心肌损害程度与IFN-γ、TNF-α呈正相关(r=0.599、0.634)(均P<0.05),与IL-4、IL-10呈负相关(r=-0.602、-0.587)(均P<0.05);血清Th1/Th2细胞因子联合、心肌酶谱联合诊断VE合并心肌损害的AUC分别为0.928(95%CI:0.883~0.959)、0.933(95%CI:0.890~0.963),两者诊断效能近似。DCA、CIC曲线显示,联合Th1、Th2细胞因子的模型诊断VE合并心肌损害净收益率、临床有效率较高。结论VE合并心肌损害患儿血清Th1/Th2细胞因子含量明显异常,且与心肌损伤程度联系密切,IFN-γ、IL-10、TNF-α、IL-4联合诊断VE合并心肌损害具有较高诊断效能及临床效益。
Objective To investigate the changes of serum Th1/Th2 cytokines in children with viral encephalitis(VE)complicated with myocardial injury and their diagnostic efficacy.Methods In total,102 children with VE complicated with myocardial injury in our hospital were selected as the research group,and following the 1∶1 allocation principle,102 patients with VE and 102 healthy children were included as control group and normal control group respectively.Serum Th1 cytokines[interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α)],Th2 cytokines[interleukin(IL)-4,IL-10],myocardial zymogram indicators[lactate dehydrogenase(LDH),myocardial injury markers creatinine I(cTnI),and creatine kinase isoenzymes(CK-MB)]were calculated in the three groups.The serum Th1/Th2 cytokines of different degrees of myocardial injury in the research group was compared,and Spearman was used to analyze the correlation between serum Th1/Th2 cytokines and the degree of myocardial injury.Receiver operating characteristic(ROC),decision curve analysis(DCA),and clinical impact curve(CIC)were drawn to analyze the diagnostic value of serum Th1/Th2 cytokines in VE combined with myocardial injury.Results The levels of serum IFN-γ,TNF-α,CK-MB,cTnI and LDH were the highest in the research group,followed by the control group and normal control group,and the levels of serum IL-4 and IL-10 were the lowest in the research group,followed by the control group and normal control group(P<0.05).The levels of serum IFN-γand TNF-αin the research group were the highest in those with severe myocardial injury,followed by those with moderate injury and those with mild injury,and the levels of serum IL-4 and IL-10 were the lowest in patients with severe myocardial injury,followed by those with moderate injury and those with mild injury(P<0.05).In children with VE complicated with myocardial injury,the degree of myocardial injury was positively correlated with IFN-γand TNF-α(r=0.599,0.634)(all P<0.05),and negatively correlated with IL-4 and IL-10(r=-0.602,-0.587)(all P<0.05).The area under the curve(AUC)of serum Th1/Th2 cytokines in combination and myocardial zymogram in combination in the diagnosis of VE complicated with myocardial injury was 0.928(95%CI:0.883-0.959)and 0.933(95%CI:0.890-0.963)respectively,showing similar diagnostic efficacy.DCA and CIC curves showed that the model combined with Th1 and Th2 cytokines in the diagnosis of VE combined with myocardial injury had higher net yield and clinical effective rate.Conclusion The serum Th1/Th2 cytokine level in children with VE complicated with myocardial injury is obviously abnormal,which is closely related to the degree of myocardial injury.The combination of IFN-γ,IL-10,TNF-αand IL-4 in combination in the diagnosis of VE complicated with myocardial injury has high diagnostic efficacy and clinical benefit.
作者
王蕾
门欣怡
袁小辉
赵慧
王薇
WANG Lei;MEN Xin-yi;YUAN Xiao-hui;ZHAO Hui;WANG Wei(Department of Pediatrics,the Second Hospital of Hebei Medical University,Hebei Province,Shijiazhuang 050000,China;Department of Traditional Chinese Medicine,Comprehensive Supervision and Service Center of Hebei Provincial Health Commission,Shijiazhuang 050000,China)
出处
《河北医科大学学报》
CAS
2024年第5期513-518,共6页
Journal of Hebei Medical University
基金
河北省医学科学研究重点课题计划(20180294)。