mcfDNA与小年龄、低体重先天性心脏病患儿体外循环手术预后的相关性研究  

Correlation of mcfDNA with the prognosis of young and low weight pediatric patient with congenital heart disease after cardiopulmonary bypass

作　　者：杨元恺 刘彩霞[2] 刘一为 文云红 刘海燕 马鞅 Yang Yuankai;Liu Caixia;Liu Yiwei;Wen Yunhong;Liu Haiyan;Ma Yang(Department of Pediatrics,Shanxi Medical University,Taiyuan 030001,China;Department of Cardiothoracic Surgery,Shanxi Children's Hospital,Taiyuan 030025,China)

机构地区：[1]山西医科大学儿科医学系,太原030001 [2]山西省儿童医院心胸外科,太原030025

出　　处：《中华小儿外科杂志》2025年第3期222-227,共6页Chinese Journal of Pediatric Surgery

基　　金：山西省“四个一批”医学重点科研项目(2022XM20)。

摘　　要：目的探讨循环游离线粒体DNA(mitochondrial cell-free DNA,mcfDNA)对先天性心脏病(congenital heart disease,CHD)体外循环手术预后的预测价值。方法前瞻性收集山西省儿童医院心胸外科2022年2月至2023年1月小年龄(<1岁)、低体重(3 kg≤体重≤8 kg)CHD患儿的临床资料。收集患儿手术切皮前、体外循环结束即刻、体外循环后12 h、体外循环后24 h的外周血标本,采用荧光定量聚合酶链反应技术检测血标本中的mcfDNA水平。根据预后情况,将CHD患儿分为预后良好组(痊愈且术后住院时间≤30 d)和预后不良组(术后30 d内死亡或术后住院时间>30 d)。分析预后良好组和预后不良组mcfDNA的变化趋势;并对不同时间点mcfDNA水平进行差异性分析。使用受试者操作特征曲线评估mcfDNA对患儿不良预后的预测价值及阈值。结果共收集到59例CHD患儿,预后良好组47例,预后不良组12例。两组患儿年龄、体重差异无统计学意义(P>0.05)。预后良好组mcfDNA水平在体外循环期间显著升高,在体外循环后12 h和24 h逐渐下降,预后不良组在体外循环期间上升,在体外循环后12 h显著升高并达到峰值,在体外循环后24 h趋于下降。两组间切皮前、体外循环结束即刻、体外循环后12 h、24 h这4个时间点mcfDNA水平差异均有统计学意义(P<0.05),预后不良组mcfDNA水平较预后良好组显著升高。体外循环后24 h mcfDNA受试者操作特征曲线下面积最大,对手术不良预后预测性能最强,其最优灵敏度和特异度分别为83.3%和85.1%,预测阈值为19533 copies/μl。结论mcfDNA水平对小年龄、低体重CHD患儿不良预后有一定预测价值,体外循环后24 h的mcfDNA水平对不良预后的预测性能最强。Objective To investigate the predictive value and optimal cutoff of mitochondrial cell-free DNA(mcfDNA)for the prognosis of congenital heart disease(CHD)surgery utilizing cardiopulmonary bypass(CPB).Methods The clinical data of 59 CHD patients under 1 year old and with a low weight(3kg≤body weight≤8kg)in the Cardiothoracic Surgery Department of Children's Hospital of Shanxi Province from February 2022 to January 2023 were prospectively collected.Peripheral blood samples were collected from the patients before skin incision(T1),immediately after CPB(T2),12h after CPB(T3),and 24h after CPB(T4).The levels of mcfDNA in the blood samples were detected by fluorescence quantitative polymerase chain reaction(PCR).Based on the prognosis,CHD patients were divided into the good prognosis group(recovered and hospital stay≤30 days)and the poor prognosis group(death within 30 days after surgery or hospital stay>30 days).Changes in the mcfDNA between the good prognosis group and the poor prognosis group were analyzed,and differences in mcfDNA levels at different time points were analyzed.The predictive value and threshold of mcfDNA for the poor prognosis in children were evaluated using receiver operating characteristic(ROC)curves.Results A total of 59 CHD patients were collected,including 47 in the good prognosis group and 12 in the poor prognosis group.There were no significant differences in age and body weight between the two groups(P>0.05).The mcfDNA level in the good prognosis group increased significantly during CPB and gradually decreased at 12 hours and 24 hours after CPB.In the poor prognosis group,the mcfDNA level increased during CPB,increased significantly and reached the peak at 12 hours after CPB,and tended to decrease at 24 hours after CPB.There were significant differences in mcfDNA levels between the two groups before skin incision,immediately after the end of CPB,12 hours after CPB,and 24 hours after CPB(P<0.05),and the mcfDNA level in the poor prognosis group was significantly higher than that of the g

关 键 词：心脏病 先天畸形 线粒体DNA 体外循环 阈值 

分 类 号：R726.5[医药卫生—儿科]