摘要
目的 探究血清无嘌呤/无嘧啶内切酶1(APE1)、Y-盒结合蛋白1(YB-1)水平与病毒性心肌炎(VMC)患儿病情严重程度及预后的关系.方法 选取2022年5月-2023年5月西安交通大学第一附属医院榆林医院儿科收治的VMC患儿152例为VMC组,根据随访1年患儿预后情况分为预后不良亚组(n=43)与预后良好亚组(n=109).另选取同期医院健康体检儿童113例为健康对照组.采用酶联免疫吸附法测定血清APE1、YB-1水平.Pearson相关性分析血清APE1、YB-1水平与心肌炎指标的相关性.多因素Logistic回归分析VMC患儿预后不良的影响因素.受试者工作特征(ROC)曲线评价血清APE1、YB-1水平对VMC患儿预后不良的预测价值.结果 VMC组患儿血清APE1、YB-1水平低于健康对照组(t/P=35.472/＜0.001、25.388/＜0.001).随访1年,152例VMC患儿预后不良发生率为28.29％(43/152).预后不良亚组LVEF、APE1、YB-1低于预后良好亚组(t/P=8.878/＜0.001、26.085/＜0.001、14.180/＜0.001),cTnI 高于预后良好亚组(t/P=2.630/0.009).Pearson 相关性分析显示,APE1、YB-1 分别与 cTnI、CK-MB 呈负相关,与 LVEF 呈正相关(APE1:r/P=-0.575/＜0.001、-0.426/0.008、0.591/＜0.001;YB-1:r/P=-0.589/＜0.001、-0.417/0.011、0.609/＜0.001).多因素 Logistic 回归结果示,LVEF 低、APE1低、YB-1 低是 VMC 患儿预后不良的独立危险因素[OR(95％CI)=3.967(1.246～12.634)、4.778(1.728～13.214)、4.914(1.851～13.041)].血清APE1、YB-1水平及二者联合预测VMC患儿预后不良的曲线下面积(AUC)分别为0.704、0.680、0.897,且二者联合的 AUC 大于血清 APE1、YB-1 水平单独预测的 AUC(Z/P=4.233/＜0.001、4.328/＜0.001).结论 VMC患儿血清APE1、YB-1水平能够反映心肌损伤和心功能情况,二者联合诊断能够显著提高VMC患儿发生预后不良的预测效能.
Abstract
Objective To investigate the relationship between serum apurinic/apyrimidinic endonuclease 1(APE1),Y-box binding protein 1(YB-1)levels and the severity and prognosis of children with viral myocarditis(VMC).Methods One hundred and fifty-two children with VMC admitted to the Department of Pediatrics in Yulin Hospital,the First Affiliated Hospital of Xi'an Jiaotong University from May 2022 to May 2023 were selected as the VMC group,according to the prog-nosis of the children after 1 year of follow-up,they were divided into poor prognosis subgroup(n=43)and good prognosis subgroup(n=109).A total of 113 healthy children in the same period were selected as the healthy control group.Serum levels of APE1 and YB-1 were measured by enzyme-linked immunosorbent assay.Pearson correlation analysis was used to analyze the correlation between serum APE1,YB-1 levels and differential indicators.Multivariate Logistic regression analysis was used to analyze the influencing factors of poor prognosis in children with VMC.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum APE1 and YB-1 levels for poor prognosis in children with VMC.Results The levels of serum APE1 and YB-1 in VMC group were lower than those in healthy control group(t/P=35.472/＜0.001;25.388/＜0.001).After 1 year of follow-up,the incidence of poor prognosis in 152 children with VMC was 2829％(43/152).LVEF,APE1 and YB-1 in the poor prognosis subgroup were lower than those in the good prognosis sub-group(t/P=8.878/＜0.001;26.085/＜0.001;14.180/＜0.001),and cTnI was higher than that in the good prognosis subgroup(t/P=2.630/0.009).Pearson correlation analysis showed that APE1 and YB-1 were negatively correlated with cTnI and CK-MB,respectively,and positively correlated with LVEF(APEl:r/P=-0.575/＜0.001,-0.426/0.008,0.591/＜0.001;YB-l:r/P=-0.589/＜0.001,-0.417/0.011,0.609/＜0.001).Multivariate Logistic regression results showed that low LVEF,low APE1 and low YB-1 were independent risk factors for poor prognosis in children with VMC[OR(95％CI)=3.967(1.246-12.634)、4.778(1.728-13214)、4.914(1.851-13.041)].The area under the curve(AUC)of serum APE1,YB-1 levels and their combination in pre-dicting poor prognosis of children with VMC were 0.704,0.680 and 0.897,respectively,and the AUC of their combination was greater than that of serum APE1 and YB-1 levels alone(Z/P=4.233/＜0.001;4.328/＜0.001).Conclusion Serum APE1 and YB-1 levels in children with VMC can reflect myocardial injury and cardiac function.The combined diagnosis of APE1 and YB-1 can significantly improve the predictive efficacy of poor prognosis in children with VMC,and provide a sufficient basis for clinical intervention.
维普
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