摘要
目的探讨心脏型脂肪酸结合蛋白(heart type fatty acid binding protein,h-FABP)不同水平的病毒性心肌炎患者临床特征及预后。方法120名病毒性心肌炎患者据入院时h-FABP水平分为低水平组(h-FABP<50.36μg/L,n=52)和高水平组(h-FABP≥50.36μg/L,n=68),收集2组患者的一般基线资料[年龄、性别、体质量指数(body mass index,BMI)、合并呼吸道感染、合并消化道感染及病情严重程度];抽取2组患者入院当日空腹静脉血,采用酶联免疫吸附测定(enzyme-linked immunosorbent assay,ELISA)法检测血清h-FABP水平,采用放射免疫法检测肌钙蛋白Ⅰ(cardiac troponinⅠ,cTnI)、肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)、肌红蛋白(myoglobin,Mb)及25-羟基维生素D[25-hydroxy vitamin D,25(OH)D]水平,采用免疫分析仪检测白细胞计数(white blood cell count,WBC)水平,速率散射比浊法检测超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)及淀粉样蛋白A(amyloid protein A,SAA)水平;采用24 h动态心电图检测快速性心律失常、Q波-R波-S波群(Q wave-R wave-S wave complex,QRS)波时限延长、心率变异性高频(high frequency,HF)及低频(low frequency,LF)指标,超声心动图检测左心室射血分数(left ventricular ejection fraction,LVEF)、每搏输出量(stroke output,SV)、每分输出量(output per minute,CO)、左室后壁厚度(left ventricular posterior wall,LVPW)、室间隔(interventricular septum,IVS)及左室收缩期内径(left ventricular internal dimension systole,LVDS)水平;2组患者连续治疗14 d,治疗完成后随访6个月评估预后良好与否;绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析h-FABP对病毒性心肌炎患者预后的预测价值。结果高水平组患者中重症、快速性心律失常、QRS波时限延长占比、LVPW、IVS、LVDS、cTnI、CK-MB、WBC、hs-CRP、Mb、SAA水平及预后不良发生率均高于低水平组,LVEF、SV、CO、HF、LF及25(OH)D水平则低于低水平组(P<0.05);低水平和高水平h-FABP预测病毒性心肌炎患者预后的曲线下面积(area under curve,AUC)分别为0.848和0.867。结论与h-FABP低水平的病毒性心肌炎患者相比,h-FABP高水平的病毒性心肌炎患者病情程度、心功能损伤及炎性反应均较重,且预后不良发生率较高。
Objective To investigate the clinical features and prognosis of patients with viral myocarditis with different levels of heart type fatty acid binding protein(h-FABP).Methods Patientswith viral myocarditis(n=120)were selected as participants and were divided into low level group(h-FABP<50.36μg/L,n=52)and high level group(h-FABP≥50.36μg/L,n=68).General baseline data[age,gender,body mass index(BMI),combined respiratory tract infection,combined digestive tract infection,and severity of illness]of the two groups on the day of admission were collected.Fasting venous blood was collected from the patients on the day of admission,and the serum h-FABP level was detected by enzyme-linked immunosorbent assay(ELISA).The levels of cardiac troponinⅠ(cTnI),creatine kinase isoenzyme(CK-MB),myoglobin(Mb),and 25-hydroxy vitamin D[25(OH)D]were detected by radioimmunoassay.The level of white blood cell count(WBC)was detected by immune analyzer.The levels of hypersensitive C-reactive protein(hs-CRP)and amyloid protein A(SAA)were examined by rate scattering turbidimetry.Tachyarrhythmia,prolonged Q wave-R wave-S wave complex(QRS)duration,high frequency(HF),and low frequency(LF)indexes of heart rate variability were detected by 24 h holter electrocardiogram.Left ventricular ejection fraction(LVEF),stroke output(SV),output per minute(CO),left ventricular posterior wall(LVPW),ventricular septum(IVS),and left ventricular internal dimension systole(LVDS)were measured by echocardiography.The two groups of patients with viral myocarditis were treated continuously for 14 d,and the prognosis was evaluated after 6 m of follow-up.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of h-FABP for the prognosis of patients with viral myocarditis.Results The incidence of severe disease severity,tachyarrhythmia,prolonged duration of QRS wave,LVPW,IVS,LVDS,cTnI,CK-MB,WBC,hs-CRP,Mb,SAA level and poor prognosis in patients in high level group were higher than those in low level group.The levels of LVEF,SV,CO,HF,LF,and 25(OH)D were lower than those of patients in low level group(P<0.05).The area under the curve(AUC)of low level and high level h-FABP in predicting the prognosis of patients with viral myocarditis was 0.848 and 0.867,respectively.Conclusion Compared with patients with viral myocarditis with low level of h-FABP,patients with viral myocarditis with high level of h-FABP have more severe disease severity,cardiac function injury and inflammatory reaction,and a higher incidence of poor prognosis.
作者
刘文明
李小英
袁自华
LIU Wenming;LI Xiaoying;YUAN Zihua(Clinical Laboratory,CITIC Huizhou Hospital,Huizhou 516006,Guangdong,China;Department of Cardiology,CITIC Huizhou Hospital,Huizhou 516006,Guangdong,China)
出处
《贵州医科大学学报》
2025年第8期1213-1219,共7页
Journal of Guizhou Medical University
基金
广东省自然科学基金项目(S2022040007724)。
关键词
心脏型脂肪酸结合蛋白
病毒性心肌炎
临床特征
预后
heart type fatty acid binding protein
viral myocarditis
clinical features
prognosis
