可溶性ACE2水平与支原体肺炎病儿心肌损伤间关系的初步探讨  

A preliminary study on the relationship between soluble ACE2 level and myocardial injury in children with mycoplasma pneumonia

作　　者：郭建明 刘春燕 刘飞飞 栗晓芳[1] 马俊帅[3] 马科[3] GUO Jianming;LIU Chunyan;LIU Feifei;LI Xiaofang;MA Junshuai;MA Ke(Department of Laboratory Pathology,81st Group Military Hospital,Zhangjiakou,Hebei 075000,China;Emergency Department of Renqiu People's Hospital,Cangzhou,Hebei 062550,China;Department of Clinical Laboratory,The First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China)

机构地区：[1]中国人民解放军陆军第八十一集团军医院检验病理科,河北张家口075000 [2]任丘市人民医院急诊科,河北沧州062550 [3]河北北方学院附属第一医院检验科,河北张家口075000

出　　处：《安徽医药》2025年第1期118-122,共5页Anhui Medical and Pharmaceutical Journal

基　　金：河北省医学科学研究课题计划项目(20232082)。

摘　　要：目的分析可溶性血管紧张素转换酶2(sACE2)水平与肺炎支原体肺炎(MPP)病儿心肌损伤的关系。方法收集2021年2月至2022年11月中国人民解放军陆军第八十一集团军医院收治的MPP病儿108例,根据病情严重程度分为重症MPP组30例和轻症MPP组78例,选取同期健康体检儿童50例为对照组;根据MPP病儿是否发生心肌损伤分为发生组23例和未发生组85例。酶联免疫吸附测定检测血清sACE2水平;收集MPP病儿临床病历资料及生化指标水平,并进行组间比较;Pearson法分析sACE2与生化指标的相关性;logistic回归分析MPP病儿发生心肌损伤的影响因素;ROC曲线分析sACE2水平对MPP病儿发生心肌损伤的预测价值。结果重症MPP组、轻症MPP组、对照组儿童血清sACE2水平[(56.19±6.13)U/L、(42.36±6.02)U/L、(28.15±5.97)U/L]依次降低,心肌损伤发生组MPP病儿血清sACE2水平高于未发生组(P<0.05);发生组和未发生组MPP病儿发热程度、肺炎支原体(MP)抗体滴度、发热持续时间、大环内酯类药物使用时间、咳嗽性质、其他肺外并发症、胸片表现、心电图异常、C反应蛋白(CRP)、乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)、磷酸肌酸激酶(CK)、红细胞分布宽度(RDW)、心肌肌钙蛋白(cTnI)、N-末端脑钠肽前体(NT-proBNP)、血小板计数(PLT)比较差异有统计学意义(P<0.05);sACE2水平与LDH、NT-proBNP、cTnI、CK、RDW、CRP呈正相关,与PLT呈负相关(P<0.05);sACE2、CK-MB是MPP病儿发生心肌损伤的影响因素(P<0.05);sACE2水平评估MPP病儿发生心肌损伤的AUC为0.94[95%CI:(0.88,0.98)],灵敏度和特异度分别为86.96%和85.88%。结论sACE2水平与MPP病儿心肌损伤具有密切关系,是MPP病儿发生心肌损伤的影响因素,对心肌损伤的发生具有一定预测价值。Objective To analyze the relationship between soluble angiotensin converting enzyme 2(sACE2)level and myocardial injury in children with Mycoplasma pneumoniae pneumonia(MPP).Methods A total of 108 children with MPP admitted to 81st Group Military Hospital from February 2021 to November 2022 were collected.According to the severity of the condition,they were grouped into a severe MPP group of 30 cases and a mild MPP group of 78 cases.Fifty healthy children who underwent physical examination during the same period were collected as the control group;children with MPP were grouped into an occurrence group of 23 cases and an non occurrence group of 85 cases based on whether they experienced myocardial injury.Enzyme-linked immunosorbent assay was applied to measure serum sACE2 level;clinical medical record data and biochemical indicators of MPP children were collected,and compared between groups;Pearson method was applied to analyze the correlation between sACE2 and biochemical indicators;Logistic regression was applied to analyze the influencing factors of myocardial injury in children with MPP;ROC curve was applied to analyze the predictive value of sACE2 level for myocardial injury in children with MPP.Results The serum level of sACE2 in children with severe MPP group,mild MPP group,and control group[(56.19±6.13)U/L,(42.36±6.02)U/L,(28.15±5.97)U/L]decreased sequentially,the serum level of sACE2 in children with MPP in the occurrence group were higher than those in the non occurrence group(P<0.05);the differences in fever severity,MP antibody titer,duration of fever,duration of macrolide medication use,cough properties,other extrapulmonary complications,chest X-ray manifestations,electrocardiogram abnormalities,C-reactive protein(CRP),lactate dehydrogenase(LDH),creatine kinase(CK-MB),phosphocreatine kinase(CK),red blood cell distribution width(RDW),cardiac troponin(cTnI),Nterminal pro-B-type natriureticpeptide(NT-proBNP)and platelet count(PLT)were statistically obvious(P<0.05);the level of sACE2 was positively co

关 键 词：肺炎 支原体 可溶性血管紧张素转换酶2 心肌损伤 影响因素 预测价值 

分 类 号：R725.6[医药卫生—儿科] R725.4[医药卫生—临床医学]