【摘要】 目的:分析淋巴细胞亚群对病毒性心肌炎患者远期生存率的预测价值。方法:分析2012年5月-2014年5月67例病毒性心肌炎患者临床资料。绘制受试者工作特征曲线（ROC）分析多种指标对病毒性心肌炎患者远期生存率的预测价值。结果:死亡组IL-6、C反应蛋白、CD4⁺/CD8⁺比例均显著高于存活组（P<0.05）。死亡组淋巴细胞数、CD8⁺比例均显著低于存活组（P<0.05）。APACHEⅡ、CK-MB、淋巴细胞计数、CD4⁺/CD8⁺比例、CD8⁺比例的ROC曲线下面积分别为0.819[95%CI（0.734,0.904）]、0.844[95%CI（0.764,0.924）]、0.896[95%CI（0.821,0.971）]、0.879[95%CI（0.802,0.956）]、0.940[95%CI（0.876,1.000）]。当CD8⁺比例取临界值为15.5%时,敏感度和特异度分别为93.3%和85.7%。当淋巴细胞数取临界值为0.63×10⁹/L时,敏感度和特异度分别为93.3%和82.1%。CD8⁺比例和淋巴细胞数分别取15.5%和0.63×10⁹/L为最佳临界值时,平行试验敏感度和特异度分别为99.6%和70.4%,约登指数为0.74;序列试验敏感度和特异度分别为87.0%和97.4%,约登指数为0.84,序列试验的诊断效能优于平行试验。与死亡相关的危险因素为CK-MB（OR=1.215,P=0.01）、CD8⁺比例（OR=0.24,P<0.01）。结论:CD8⁺比例和淋巴细胞数可用于预测病毒性心肌炎患者远期生存率。当CD8⁺比例和淋巴细胞数分别取15.5%和0.63×10⁹/L为最佳临界值时,序列试验优于平行试验,CK-MB和CD8⁺比例是病毒性心肌炎患者死亡的独立危险因素。更多还原

【Abstract】 Objective:To investigate predictive value of lymphocyte subpopulation on evaluation of longterm survival in patients with viral myocarditis.Method:A total of 67 patients with viral myocarditis were enrolled from May 2012 to May 2014 prospectively.ROC curve was done to analyze predictive value of indicators on long-term survival in these patients.Result:IL-6,CRP,CD4⁺/CD8⁺ ratio of the death group were significantly higher than those of the survival group（P<0.05）.Lymphocyte count and CD8⁺ ratio of the death group were significantly lower than those of the survival group（P<0.05）.Aera under ROC of APACHEⅡ,CK-MB,lymphocyte count,CD4⁺/CD8⁺ ratio and CD8⁺ ratio were 0.819[95%CI（0.734,0.904）],0.844[95%CI（0.764,0.924）],0.896[95%CI（0.821,0.971）],0.879[95%CI（0.802,0.956）],0.940[95%CI（0.876,1.000）].When the optimal cutoff value of CD8⁺ ratio was 15.5%,sensitivity and specificity were respectively 93.3% and 85.7%.When the optimal cutoff value of lymphocyte count was 0.63×10⁹/L,sensitivity and specificity were respectively 93.3% and 82.1%.The efficacy of serial test（sensitivity:87.0%,specificity:97.4%,Yuden Index:0.84） was better than that of parallel test（sensitivity:99.6%,specificity:70.4%,Yuden Index:0.74）.CK-MB（OR=1.215,P=0.01） and CD8⁺ ratio（OR=0.24,P<0.01） were the death cause and risk factors of viral myocarditis.Conclusion:CD8⁺ ratio and lymphocyte count could be helpful to predicting long-term survival rate in patients with viral myocarditis.When the optimal cutoff value of CD8⁺ ratio and lymphocyte count are 15.5% and 0.63×10⁹/L.The efficacy of serial test is better than that of parallel test.CK-MB and CD8⁺ ratio are the death cause and risk factors of viral myocarditis.更多还原