摘要
目的 联合几项免疫介导的血清学指标来提高对儿童儿童病毒性心肌炎(VMC)的诊断效率,为临床提供早期的诊断价值,避免漏检对患儿引起的不良结局.方法 收集泗洪医院2018年1月至2022年6月在儿科住院就诊符合条件的45例VMC病例纳入VMC组,45例单纯病毒感染患儿纳入NVMC组以及体检的50名正常儿童纳入对照组.收集研究对象一般资料,包括白细胞介素6(IL-6)、谷胱甘肽还原酶(GR)、一氧化氮(NO)以及心肌酶谱、肌钙蛋白结果.用受试者工作特征(ROC)曲线各单项指标对VMC的价值分析,并采用Logistic回归模型构建模型来预判VMC.结果 VMC组的肌酸激酶同工酶(CK-MB)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、肌钙蛋白I(cTnI)、NO、IL-6含量明显高于NVMC组和对照组,而GR含量则明显低于后两组;用各单项指标来对VMC进行ROC曲线分析,结果显示特异性最高的是cTnI的0.907,敏感性最高的是IL-6的0.912,AUC面积最大的是NO,为0.883;由cTnI、CK-MB、GR、NO、IL-6等5项指标联合建立的回归模型,当诊断界值定为0.55时,模型对VMC的AUC为0.976,敏感性为0.977,特异性为0.982,此时约登指数最大为0.959.结论 用NO、GR、IL-6联合cTnI、CK-MB构建的回归模型对VMC的诊断特异性以及敏感性明显高于其他的单一指标.能够为临床医生及早的诊断儿童VMC提供有力的依据和辅助.
Abstract
Objective To improve the diagnostic efficiency of viral myocarditis(VMC)in chil-dren by combining several immune mediated serological indicators,to provide early diagnostic value for clini-cal use,and to avoid adverse outcomes caused by missed detection.Methods 45 eligible VMC cases who were hospitalized in the Pediatric Department of Sihong Hospital from January 2018 to June 2022 were collect-ed and included in the VMC group,45 children with simple virus infection were included in the NVMC group,and 50 normal children who underwent physical examination were included in the control group.Gener-al information of the research subjects was collected,including interleukin-6(IL-6),glutathione reductase(GR),nitric oxide(NO),as well as myocardial enzyme spectrum and troponin results.The value of individu-al indicator of the receiver operating characteristic(ROC)curve was used to analyze the value of VMC,and a logistic regression model was used to build a model to predict VMC.Results The contents of CK-MB,AST,LDH,cTnI,NO and IL-6 in the VMC group were significantly higher than those in the NVMC group and the control group,while the contents of GR were significantly lower than those in the latter two groups;Using each single indicator to analyze the ROC curve of VMC,the results showed that the largest AUC area was NO(0.883),the highest specificity was 0.907 of cTnI,and the highest sensitivity was 0.912 of IL-6;When the di-agnostic cut-off value of the regression model jointly established by five indicators(cTnI,CK-MB,GR,NO,IL-6,etc.)is 0.55,the sensitivity is 0.977,the specificity is 0.982,the maximum Yoden index is 0.959,and the AUC is 0.976.Conclusion The specificity and sensitivity of the regression model constructed with NO,GR,IL-6 combined with cTnI and CK-MB in the diagnosis of VMC are significantly higher than other single indica-tors.It can provide a powerful basis and assistance for clinicians to diagnose VMC in children as early as possible.
NETL
NSTL
维普
万方数据