Serum PLN and CD40L Levels and Their Prognostic Value in Patients with Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy
Objective To investigate the expression and prognostic value of phospholamban(PLN)and CD40 ligand(CD40L)in the serum of patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy(ARVD/C).Methods From January 2016 to October 2020,124 patients with ARVD/C admitted to our hospital were regarded as the research objects.ARVD/C patients were grouped into good prognosis group(n=86)and poor prognosis group(n=40)according to whether malignant arrhythmia events(MAE)occurred within 18 months.The patient's age,gender,body mass index(BMI),past history,laboratory indicators and other data were collected.The levels of PLN and CD40L in serum of patients were detected by enzyme-linked immunosorbent assay.The correlation between serum PLN and CD40L levels and clinical indicators in patients with ARVD/C was analyzed by Pearson's method.The predictive value of PLN and CD40L for MAE in ARVD/C patients was evaluated by receiver operating characteristic(ROC)curve.The relationship between PLN,CD40L and MAE-free survival of patients was analyzed by Kaplan-Meier curve.Multivariate Cox regression was applied for the influencing factors of MAE in ARVD/C patients.Results Serum levels of PLN,CD40L,hsCRP,NT-proBNP and CK-MB in the poor prognosis group were greatly higher than those in the good prognosis group(P＜0.05).Serum PLN and CD40L levels were positively correlated with hsCRP level(r=0.347,0.451,all P＜0.05).The ROC curve showed that the AUC of PLN and CD40L for predicting MAE in patients with ARVD/C was 0.782 and 0.781,the AUC of the two combination to predict MAE after ARVD/C was 0.867(Zcombination vs PLN=2.367,Zcombination vs CD40L=2.003,all P＜0.05),the sensitivity and specificity were 67.50％and 95.24％,respectively.Kaplan-Meier curve analysis showed that the MAE free survival rate(53.73％)in patients with high PLN expression of ARVD/C was lower than that in patients with low PLN expression of ARVD/C(84.21％)(Log Rank x2=6.389,P＜0.001).The MAE free survival rate of patients with high CD40L expression of ARVD/C(51.72％)was lower than that of patients with low CD40L expression of ARVD/C(81.82％)(Log Rank x2=6.691,P＜0.001).Cox regression analysis found that PLN and CD40L were risk factors for MAE in ARVD/C patients(P＜0.05).Conclusion The serum levels of PLN,CD40L,hsCRP,NT-proBNP,and CK-MB in ARVD/C patients with poor prognosis are greatly higher than those in ARVD/C patients with good prognosis.The combined detection of serum PLN and CD40L has a certain predictive value for the occurrence of MAE in patients with ARVD/C.
PhospholambanCD40 ligandArrhythmogenic right ventricular dysplasia/cardiomyopathyMalignant arrhythmia events
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