【摘要】 目的检测扩张型心肌病(dilated cardiomyopathy,DCM)患者血清抗毒覃碱型乙酰胆碱受体抗体(muscarinic acetylcholine receptor antibody,CHRM3-Ab)与白细胞介素(interleukin,IL)-27的浓度,分析其与DCM疾病的关系。方法选取2016年6月至2018年3月西安交通大学第一附属医院收治的267例DCM患者为研究组,根据纽约心脏协会(New York Heart Association,NYHA)心功能分级,NYHAⅡ级76例,NYHAⅢ级105例,NYHAⅣ级86例;选取同期经冠状动脉计算机断层扫描血管造影(CTA)、心脏超声等检查无异常的健康体检者200名为对照组。采用酶联免疫吸附法(ELISA)检测受试者血清抗CHRM3-Ab与IL-27浓度,利用常规二维超声心动图检查受试者左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)、左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)、左心室短轴缩短率(left ventricular fractional shortening,LVFS)、左心室收缩末期容积(left ventricular end-systolic volume,LVESV)。结果研究组LVEDD、LVESV、LVEDV较对照组显著升高,差异有统计学意义(P<0.05)。研究组LVEF、LVFS较对照组显著降低,差异有统计学意义(P<0.05)。研究组血清抗CHRM3-Ab浓度显著高于对照组,差异有统计学意义(P<0.05)。研究组血清IL-27浓度显著低于对照组,差异有统计学意义(P<0.05)。随着DCM患者NYHA心功能分级升高,其血清IL-27浓度逐渐降低(P<0.05),血清抗CHRM3-Ab浓度逐渐升高(P<0.05);随着DCM患者NYHA心功能分级升高,LVEDD、LVESV、LVEDV逐渐升高(P<0.05),LVEF、LVFS逐渐降低(P<0.05)。Pearson相关分析结果显示,DCM患者血清抗CHRM3-Ab浓度与IL-27浓度呈负相关(P<0.05);血清抗CHRM3-Ab浓度与LVEDD、LVESV、LVEDV呈正相关,与LVEF、LVFS呈负相关(P<0.05);血清IL-27浓度与LVEDD、LVESV、LVEDV呈负相关,与LVEF、LVFS呈正相关(P<0.05)。受试者工作特征曲线分析结果显示,血清抗CHRM3-Ab诊断DCM的曲线下面积为0.741,灵敏度为56.90%,特异度为85.00%;血清IL-27诊断DCM的曲线下面积为0.902,灵敏度为91.70%,特异度为87.00%。结论 DCM患者血清IL-27较抗CHRM3-Ab对DCM具有更高的诊断价值,IL-27可作为DCM诊断的生物标志物。更多还原

【Abstract】 Objectives To detect the concentrations of anti-muscarinic acetylcholine receptor antibody(CHRM3-Ab)and interleukin-27(IL-27) in patients with dilated cardiomyopathy(DCM),and to analyze their relationship with DCM.Methods Totally 267 patients with DCM admitted to The First Affiliated Hospital of Xi’an Jiaotong University from June 2016 to March 2018 were selected as the study group.According to New York Heart Association(NYHA)cardiac function classification,76 cases were in NYHA Ⅱ cardiac function classification,105 cases were in NYHA Ⅲcardiac function classification and 86 cases were in NYHA Ⅳ cardiac function classification.At the same period,200 healthy people who underwent coronary angiography and echocardiography were selected as the control group.Serum concentrations of anti-CHRM3-Ab and IL-27 were detected by enzyme-linked immunosorbent assay(ELISA).Left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-diastolic volume(LVEDV),left ventricular fractional shortening(LVFS) and left ventricular end-systolic volume(LVESV)were measured by conventional two-dimensional echocardiography.Results LVEDD,LVESV and LVEDV in study group were significantly higher than those in control group(P<0.05),while LVEF and LVFS in study group were significantly lower than those in control group(P<0.05).Serum concentration of anti-CHRM3-Ab in study group was significantly higher than that in control group(P<0.05),and serum concentration of IL-27 in study group was significantly lower than that in control group(P<0.05).With the increase of NYHA cardiac function grade in patients with DCM,serum concentration of IL-27 gradually decreased(P<0.05),and serum concentration of anti-CHRM3-Ab gradually increased(P<0.05).With the increase of NYHA cardiac function grade in patients with DCM,LVEDD,LVESV,and LVEDV gradually increased(P<0.05),while LVEF and LVFS gradually decreased(P<0.05).Pearson test showed that there was a negative correlation between serum concentration of anti-CHRM3-Ab and IL-27 in patients with DCM(P<0.05);there were positive correlations between serum concentration of anti-CHRM3-Ab with LVEDD,LVESV and LVEDV;there were negative correlations between serum concentration of anti-CHRM3-Ab with LVEF and LVFS(P<0.05).Serum concentration of IL-27 negatively correlated with LVEDD,LVESV and LVEDV,and positively correlated with LVEF and LVFS(P<0.05).Receiver operating characteristic curve analysis result showed that the area under the curve of serum anti-CHRM3-Ab for diagnosing DCM was 0.741,the sensitivity was 56.90% and the specificity was 85.00%;the area under the curve of serum IL-27 for diagnosing DCM was 0.902,the sensitivity was 91.70%and the specificity was 87.00%.Conclusions Serum concentration of IL-27 is more valuable than anti-CHRM3-Ab in the diagnosis of DCM.Serum concentration of IL-27 may be a biological molecule in the diagnosis of DCM.更多还原