目的 探讨病毒性心肌炎(VMC)患者血清钙卫蛋白A4(S100A4)、钙卫蛋白A8/A9(S100A8/A9)与病情及预后不良的关系。方法 选取2020-11至2022-11武警广东总队医院收治的151例VMC患者,根据病情严重程度分为轻症组(87例)与重症组(64例),同期选取90例在该医院体检的志愿者作为健康组,比较三组入院时的基线资料及血清S100A4、S100A8/A9表达水平。对所有VMC患者随访1年,根据是否发生不良事件分为不良预后组和良好预后组。采用多因素logistic回归分析VMC不良预后的影响因素,受试者工作特征(ROC)曲线分析血清S100A4、S100A8/A9对患者不良预后的预测效能。结果 轻症和重症组血清S100A4、S100A8/A9水平均高于健康组(P＜0.05),且重症组的血清S100A4、S100A8/A9水平高于轻症组(P＜0.05)。相较于良好预后组,不良预后组的房室传导阻滞占比、心肌肌钙蛋白Ⅰ、肌酸激酶同工酶、血清S100A4、血清S100A8/A9水平升高(P＜0.05),左室射血分数值降低(P＜0.05)。房室传导阻滞(OR=1.850,95%CI:1.369~2.511)、心肌肌钙蛋白Ⅰ升高(OR=1.738,95%CI:1.285~2.306)、肌酸激酶同工酶升高(OR=1.677,95%CI:1.213~2.127)、S100A4升高(OR=1.409,95%CI:1.021~1.869)、S100A8/A9升高(OR=1.493,95%CI:1.115~1.936)是VMC不良预后的危险因素,左室射血分数升高(OR=0.627,95%CI:0.558~0.815)是保护因素(P＜0.05)。ROC曲线结果显示,血清S100A4、S100A8/A9预测VMC不良预后的AUC分别为0.675、0.719。血清S100A4、S100A8/A9联合预测VMC不良预后的AUC为0.784,大于S100A4或S100A8/A9单独检测。结论 血清S100A4、S100A8/A9高表达与VMC患者病情加重及不良预后的发生有关,两指标联合检测可提升对患者不良预后的预测效果。
Abstract
Objective To investigate the relationship between serum calprotectin A4 (S100A4), calprotectin A8/A9 (S100A8/A9) and disease condition and poor prognosis in patients with viral myocarditis (VMC). Methods A total of 151 VMC patients admitted to Guangdong Provincial Corps Hospital of Chinese People's Armed Police Force from November 2020 to November 2022 were divided into a mild group (87 cases) and a severe group (64 cases) according to the severity of the disease. During the same period, 90 healthy volunteers who underwent physical examination in the same hospital were selected as a healthy group. The baseline data and serum S100A4 and S100A8/A9 expression levels in the three groups at admission were compared. All VMC patients were followed up for 1 year, and divided into poor prognosis group and good prognosis group according to the occurrence of adverse events. The influencing factors affecting the poor prognosis of VMC were analyzed by multivariate Logistic analysis, the predictive efficacy of serum S100A4 and S100A8/A9 on the poor prognosis of patients was analyzed by receiver operating characteristic (ROC) curve. Results The levels of serum S100A4 and S100A8/A9 in mild and severe groups were higher than those in healthy group (P＜0.05), and the levels of serum S100A4 and S100A8/A9 in severe group were higher than those in mild group (P＜0.05). Compared with the good prognosis group, the poor prognosis group showed an increase in the proportion of atrioventricular block, cardiac troponin I, creatine kinase isoenzyme, serum S100A4, and serum S100A8/A9 levels (P＜0.05), and a decrease in left ventricular ejection fraction (P＜0.05). Atrioventricular block (OR=1.850,95%CI:1.369-2.511), elevated cardiac troponin I (OR=1.738,95%CI:1.285-2.306), elevated creatine kinase isoenzyme (OR=1.677,95%CI:1.213-2.127), elevated S100A4 (OR=1.409,95%CI:1.021-1.869), and elevated S100A8/A9(OR=1.493,95%CI:1.115-1.936) were risk factors for poor prognosis of VMC, while elevated left ventricular ejection fraction (OR=0.627,95%CI:0.558-0.815) was a protective factor (P＜0.05). ROC curve results showed that the AUC of serum S100A4 and S100A8/A9 to predict the poor prognosis of VMC was 0.675 and 0.719, respectively. The AUC of combining serum S100A4 and S100A8/A9 to predict the poor prognosis of VMC was 0.784, which was greater than that of S100A4 or S100A8/A9 alone. Conclusions The high expression of serum S100A4 and S100A8/A9 is related to the aggravation of VMC and the occurrence of poor prognosis in VMC patients. The combined detection of the two indicators can improve the prediction efficiency of poor prognosis in patients.
关键词
病毒性心肌炎 /
钙卫蛋白A4 /
钙卫蛋白A8/A9 /
预后 /
预测价值
Key words
viral myocarditis /
calprotectin A4 /
calprotectin A8/A9 /
prognosis /
predictive value
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基金
广东省医学科研基金指令性课题项目(C2020009)
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