摘要
目的 探讨先天性心脏病(CHD)患儿血清转甲状腺素蛋白(TTR)的检测水平及意义.方法 回顾性选取2020年1月至2022年1月在上海市交通大学附属新华医院接受的CHD患儿120例为研究对象(CHD组).根据有无心力衰竭发生进一步将研究对象分为心力衰竭组(n=40)和非心力衰竭组(n=80).选取120名同期体检健康儿童为对照组.收集研究对象左心房内径指数(LADI)、左心室舒张末内径指数(LEVDDI)、左心室舒张末期容量指数(LEVDVI)、左心室射血分数(LEVF)、白细胞介素(IL)-6、IL-1β、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平.采用酶联免疫吸附试验检测血清TTR水平.采用Logistic回归分析CHD形成心力衰竭的影响因素.采用Pearson法分析CHD患儿血清中TTR水平与实验室指标的相关性.采用受试者工作特征(ROC)曲线分析血清中TTR对患儿CHD发生及CHD形成心力衰竭的预测价值.结果 CHD组TTR水平为(306.52±84.38)mg/L,低于对照组[(422.36 ±118.62)mg/L],差异有统计学意义(P＜0.05).ROC结果显示,TTR水平预测CHD发生的敏感度为89.17％,特异度为70.83％,曲线下面积(AUC)为0.837(95％CI:0.785～0.882),预测价值较好(P＜0.05).心力衰竭组的LADI、LEVDDI、LEVDVI、LEVF、IL-6、IL-1 β、TNF-α、CRP水平均显著高于非心力衰竭组,TTR水平显著低于非心力衰竭组,差异均有统计意义(P＜0.05).CHD 患儿血清 TTR 水平与 LADI、LEVDDI、LEVDVI、LEVF、IL-6、IL-1β、TNF-α、CRP水平呈负相关(P＜0.05).Logistic结果显示,LADI、IL-6、IL-1β均是影响CHD患儿心力衰竭的独立危险因素,高水平TTR是影响CHD患儿心力衰竭的独立保护因素(P＜0.05).ROC曲线结果显示,TTR水平预测CHD患儿形成心力衰竭的敏感度为95.00％,特异度为73.75％,AUC为0.911(95％CI:0.845～0.955).结论 TTR在CHD患儿血清中水平下降,参与CHD的发生、发展,是CHD形成心力衰竭的独立保护因素.
Abstract
Objective To explore the detection level and significance of serum transthyretin(TTR)in children with congenital heart dis-ease(CHD).Methods A total of 120 children with CHD who were accepted by Xinhua Hospital,Shanghai Jiaotong University from January 2020 to January 2022 were retrospectively selected as the study subjects(CHD group).According to the presence or absence of heart failure,the subjects were further divided into 40 cases of heart failure group and 80 cases of non-heart failure group.A total of 120 healthy children were se-lected as the control group.The left atrial diameter index(LADI),left ventricular end diastolic diameter index(LEVDDI),left ventricular end diastolic volume index(LEVDVI),left ventricular ejection fraction(LEVF),the levels of interleukin-6(IL-6),IL-1β,tumor necrosis fac-tor-α(TNF-α)and C-reactive protein(CRP)were collected.The serum TTR level was detected by ELISA.The influencing factors of heart failure in CHD was analyzed by Logistic regression.The correlation between serum TTR level and laboratory indicators in children with CHD was analyzed by Pearson method.The predictive value of TTR in serum for the occurrence of CHD and heart failure caused by CHD was analyzed by re-ceiver operating characteristic(ROC)curve.Results The TTR level in the CHD group was(306.52±84.38)mg/L,which was lower than that in the control group(422.36±118.62)mg/L),and the difference was statistically significant(P＜0.05).The ROC results showed that the sensitivity of TTR level in predicting the occurrence of CHD was 89.17％,the specificity was 70.83％,and the area under the curve(AUC)was 0.837(95％CI:0.785-0.882),indicating good predictive value(P＜0.05).The LADI,LEVDDI,LEVDVI,LEVF,and the levels of IL-6,IL-1 β,TNF-α and CRP in heart failure group were higher than those non-heart failure group,while the level of TTR was lower than that non-heart failure group,and the difference was statistically significant(P＜0.05).The serum TTR level in children with CHD was negatively correlated with LADI,LEVDDI,LEVDVI,LEVF,IL-6,IL-1β,TNF-α and CRP levels(P＜0.05).Logistic results showed that LADI,IL-6 and IL-1β were independent risk factors for heart failure in children with CHD,and high level TTR was independent protective factor for heart failure in children with CHD(P＜0.05).The ROC curve results showed that the sensitivity and specificity of TTR level in predicting heart failure in children with CHD were 95.00％,73.75％,and AUC was 0.911(95％CI:0.845-0.955).Conclusion The level of TTR in the serum of children with CHD decreases,it is involved in the occurrence and development of CHD,and is an independent protective factor for CHD to form heart failure.
维普
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