血清APE1、YB-1水平与病毒性心肌炎患儿病情严重程度及预后关系研究  

Relationship between the serum levels of APE1 and YB-1 and the severity and prognosis of viral myocarditis in children

作　　者：李欣[1] 贺碧海 张妮妮 史楠楠 刘赟 宋彩虹 贺兆平 Li Xin;He Bihai;Zhang Nini;Shi Nannan;Liu Yun;Song Caihong;He Zhaoping(Department of Pediatrics,Yulin Hospital,First Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Province,Yulin 719000,China;不详)

机构地区：[1]西安交通大学第一附属医院榆林医院儿科,陕西榆林719000 [2]西安交通大学第一附属医院榆林医院新生儿科,陕西榆林719000

出　　处：《疑难病杂志》2024年第12期1439-1443,1449,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：陕西省重点研发计划项目(2022-YBSF-417)。

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。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 prognosis 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 28.29%(43/152).LVEF,APE1 and YB-1 in the poor prognosis subgroup were lower than those in the good prognosis subgroup(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(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).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%C

关 键 词：病毒性心肌炎 无嘌呤/无嘧啶内切酶1 Y-盒结合蛋白1 预后 儿童 

分 类 号：R725.4[医药卫生—儿科]