致心律失常性右室发育不良/心肌病患者血清PLN、CD40L水平及其预后预测价值  

Serum PLN and CD40L Levels and Their Prognostic Value in Patients with Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy

作　　者：张曼 苗睿 高淑贤 冯明利 郝亚逢[1] 王献忠[1] ZHANG Man;MIAO Rui;GAO Shuxian;FENG Mingli;HAO Yafeng;WANG Xianzhong(Second Department of Cardiology,The First Hospital of Handan City,Handan 050000,Hebei,China)

机构地区：[1]邯郸市第一医院心内二科,河北邯郸050000

出　　处：《中国分子心脏病学杂志》2024年第1期5881-5886,共6页Molecular Cardiology of China

基　　金：河北省卫生健康委员资助项目(20220498)。

摘　　要：目的探讨受磷蛋白(PLN)、Ⅱ型跨膜蛋白CD40配体(CD40L)在致心律失常性右室发育不良/心肌病(ARVD/C)患者血清中的表达及其对预后的预测价值。方法选择2016年1月至2020年10月收治的124例ARVD/C患者为研究对象,根据ARVD/C患者18个月内是否发生恶性心率失常事件(MAE)分为预后良好组(86例)和预后不良组(40例)。收集患者年龄、性别、体重指数(BMI)、既往史、实验室指标等资料。酶联免疫吸附法检测患者血清中PLN、CD40L水平。采用Pearson法分析ARVD/C患者血清PLN、CD40L水平与临床指标的相关性。采用受试者操作特征(ROC)曲线评估PLN、CD40L对ARVD/C患者MAE的预测价值。通过Kaplan-Meier曲线分析PLN、CD40L与患者无MAE生存情况的关系。采用多因素Cox回归分析ARVD/C患者MAE的影响因素。结果预后不良组血清PLN、CD40L、超敏C反应蛋白(hsCRP)、N末端B型利钠肽原(NT-proBNP)、肌酸激酶同工酶(CK-MB)水平显著高于预后良好组(P均<0.05)。血清PLN、CD40L水平均与hsCRP水平呈正相关(r=0.347、0.451,P均<0.05)。ROC曲线显示,PLN、CD40L预测ARVD/C患者MAE的曲线下面积(AUC)为0.782、0.781,二者联合对ARVD/C后MAE预测的AUC为0.867(Z_(联合vs PLN)=2.367、Z_(联合vs CD40L)=2.003,P均<0.05),灵敏度、特异度分别为67.50%、95.24%。Kaplan-Meier曲线分析显示,PLN高表达ARVD/C患者无MAE生存率(53.73%)低于PLN低表达ARVD/C患者(84.21%)(Log Rankχ^(2)=6.389,P<0.001),CD40L高表达ARVD/C患者无MAE生存率(51.72%)低于CD40L低表达ARVD/C患者(81.82%)(Log Rankχ^(2)=6.691,P<0.001)。Cox回归分析发现,PLN、CD40L是ARVD/C患者发生MAE的危险因素(P均<0.05)。结论预后不良ARVD/C患者血清PLN、CD40L、hsCRP、NT-proBNP、CK-MB水平显著高于预后良好者,血清PLN、CD40L联合检测对ARVD/C患者发生MAE具有一定预测价值。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 hs CRP 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(Z_(combination vs PLN)=2.367,Z_(combination 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 Rankχ^(2)=6.389,P<0.001).The MAE free survival rate of patients with high CD40L expression of ARVD/C(51

关 键 词：受磷蛋白 Ⅱ型跨膜蛋白CD40配体 致心律失常性右室发育不良/心肌病 恶性心率失常事件 

分 类 号：R541.7[医药卫生—心血管疾病] R542.2[医药卫生—内科学]