【摘要】 目的 评估系统性炎症反应指数(systemic inflammatory response index,SIRI)、乳酸脱氢酶(lactic dehydrogenase,LDH)及天冬氨酸转氨酶(aspertate aminotransferase,AST)用于识别成人暴发性心肌炎(fulminant myocarditis,FM)高危人群的价值。方法 选取浙江大学医学院附属金华医院2018年1月至2023年12月收治的131例成人心肌炎患者作为研究对象，根据病情分为FM组(n=54)和非FM组(n=77)。比较两组患者入院时的白细胞计数、嗜中性粒细胞计数、单核细胞计数、淋巴细胞计数、血小板计数、SIRI、C反应蛋白、肌酸激酶、肌酸激酶同工酶、LDH、AST、心肌肌钙蛋白I的差异，采用Logistic回归分析影响因素，采用受试者操作特征(receiver operating characteristic,ROC)曲线分析预测价值。结果 非FM组患者入院时的SIRI、肌酸激酶、肌酸激酶同工酶、LDH、AST、心肌肌钙蛋白I均低于FM组，两组比较差异有统计学意义(P<0.05);ROC曲线分析结果表明，LDH和AST的预测效果较佳，敏感度LDH为75.5%、AST为84.9%，特异性LDH为97.3%、AST为90.4%；多因素Logistic回归分析结果表明，LDH>633.00U/L、AST>80.45 U/L、SIRI>2.595×109/L是心肌炎患者发展成FM的高危因素。结论 心肌炎发病早期，患者的SIRI、LDH及AST对识别成人FM高危人群有一定的参考价值。更多还原

【Abstract】 Objective To evaluate the value of systemic inflammatory response index(SIRI), lactate dehydrogenase(LDH) and aspertate aminotransferase(AST) which is used to identify the high-risk population of adult fulminant myocarditis(FM). Methods A total of 131 adult myocarditis patients admitted to Affiliated Jinhua Hospital, Zhejiang University School of Medicine from January 2018 to December 2023 were selected as the study objects and divided into FM group(n=54) and non-FM group(n=77)according to their conditions. Differences of leukocyte count, neutrophil count, monocyte count, lymphocyte count, SIRI, C reactive protein, creatine kinase, creatine kinase, LDH, AST, and cardiac troponin I were compared. Influencing factors were analyzed by Logistic regression, and receiver operating characteristic(ROC) curve was used to analyze the predictive value.Results Upon admission, patients in non-FM group exhibited significantly lower levels of SIRI, creatine kinase, creatine kinase isoenzyme, LDH, AST, and cardiac troponin I compared to those in FM group with statistical significance(P<0.05). Through ROC curve analysis, it was determined that the predicted effect of LDH and AST was superior. The sensitivity of LDH and AST were found to be 75.5% and 84.9%, respectively, with corresponding specificity levels of 97.3% and 90.4%. The results of the multivariate Logistic regression analysis indicated that elevated levels of LDH>633.00U/L, AST>80.45U/L, and SIRI>2.595×109/L were identified as significant risk factors associated with the development of FM in patients with myocarditis.Conclusion In the early stage of myocarditis, SIRI, LDH and AST have certain reference value for identifying the high-risk group of adult FM.更多还原