急性心肌炎患者血清Presepsin和GDF-15水平及其与炎症水平和心功能的相关性

Serum Presepsin and GDF-15 levels in patients with acute myocarditis and their correlation with inflammatory level and cardiac function

目的探讨急性心肌炎患者血清可溶性CD14亚型(Presepsin)、生长分化因子15(GDF-15)水平及其与炎症因子水平、心功能指标的关系。方法选取2020年10月至2021年10月于内蒙古医科大学附属医院诊治的50例急性心肌炎患者作为病例组,同期体检的80例健康人作为对照组。酶联免疫吸附法(ELISA)测定血清Presepsin、GDF-15和炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)]水平。超声心动图检测心功能指标[左室射血分数(LVEF)、左室质量指数(LVMI)、左室舒张末期内径(LVEDD)]。Pearson法分析急性心肌炎患者血清Presepsin与GDF-15水平相关性,以及两者水平与炎症水平、心功能的相关性。ROC曲线分析血清Presepsin、GDF-15水平对急性心肌炎的诊断价值。结果与对照组相比,病例组患者高胆固醇比例、血清Presepsin、GDF-15、IL-6、TNF-α、hs-CRP水平以及LVEDD、LVMI显著升高,但LVEF显著下降,差异均有统计学意义(P<0.05)。Pearson分析显示急性心肌炎患者血清Presepsin与GDF-15水平呈正相关,二者分别与IL-6、TNF-α、hs-CRP、LVEDD、LVMI呈正相关,与LVEF呈负相关(P<0.05)。ROC曲线分析显示血清Presepsin、GDF-15水平诊断急性心肌炎的曲线下面积分别为0.873、0.816,最佳截断值分别为77.62 pg/mL、96.80 pg/mL时,其敏感度分别为68.00%、80.00%,特异度分别为95.00%、70.00%;二者联合诊断急性心肌炎的曲线下面积、敏感度、特异度分别为0.908、86.00%、81.25%。结论急性心肌炎患者血清Presepsin、GDF-15水平显著增加,与炎症水平、左室重构密切相关,两指标对急性心肌炎有一定的诊断价值,两者联合诊断效能更高。

Objective To investigate the levels of serum soluble CD14 subtype(Presepsin)and growth differentiation factor 15(GDF-15)in patients with acute myocarditis and their correlation with inflammation factor levels and cardiac function indexes.Methods Fifty patients with acute myocarditis diagnosed and treated in the Affiliated Hospital of Inner Mongolia Medical University from October 2020 to October 2021 were selected as the case group,and 80 healthy people who received physical examination in the same period were selected as the control group.Enzyme linked immunosorbent assay(ELISA)was used to determine the serum levels of Presepsin,GDF-15,and inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),hypersensitive C-reactive protein(hs-CRP)].The indexes of cardiac function[left ventricular ejection fraction(LVEF),left ventricular mass index(LVMI),and left ventricular end diastolic diameter(LVEDD)]were measured by echocardiography.Pearson method was used to measure and analyze the correlation between serum Presepsin and GDF-15 levels in patients with myocarditis,and the correlation of the two indexes levels with the inflammation and cardiac function.ROC curve was applied to determine the diagnostic value of serum Presepsin and GDF-15 levels for acute myocarditis.Results Compared with the control group,the proportion of hypercholesterolemia,the serum levels of Presepsin,GDF-15,IL-6,TNF-α,hs-CRP and the values of LVEDD and LVMI in the case group were significantly higher(P<0.05),but LVEF was significantly lower(P<0.05).Pearson analysis showed that serum Presepsin was positively correlated with GDF-15 levels in patients with acute myocarditis(P<0.05),and they were respectively correlated with IL-6,TNF-α,hs-CRP,LVEDD and LVMI levels,while negatively correlated with LVEF(P<0.05).ROC curve analysis showed that the area under the curve of serum Presepsin and GDF-15 levels in diagnosis of acute myocarditis was 0.873 and 0.816,respectively.When the optimal cut-off values was 77.62 pg/mL and 96.80 pg/mL,the sensitivity was 68.00%and 80.00%and the specificity was 95.00%and 70.00%,respectively.The area under the curve,sensitivity and specificity of the combined diagnosis for acute myocarditis were 0.908,86.00%and 81.25%,respectively.Conclusion The levels of serum Presepsin and GDF-15 in patients with acute myocarditis are obviously increased,which are closely related to the level of inflammation and left ventricular remodeling.The two indexes have certain diagnostic value for the occurrence of acute myocarditis,and their combined diagnostic value is higher.