病毒性心肌炎患儿外周血sCD40L和hsCRP含量变化及其临床意义

发布时间：2018-05-04 11:25

  本文选题：病毒性心肌炎 + 儿童　； 参考：《山东大学》2012年硕士论文

【摘要】：目的： 病毒性心肌炎的发病机制尚未完全阐明,目前认为病毒的直接损伤和病毒感染介导的免疫反应导致的心肌损伤是其主要发病机制,其中T细胞介导的免疫反应起重要作用。在T细胞活化所需要的共刺激信号通路中,CD40-CD40L是重要的共刺激信号分子,sCD40L是CD40L的可溶性形式,可与CD40结合而起作用。超敏C反应蛋白(hsCRP)是用超敏方法检测到的低浓度CRP,其灵敏度较CRP高。本研究旨在通过检测病毒性心肌炎患儿治疗前后外周血sCD40L与hsCRP含量的变化,探讨sCD40L与hsCRP在病毒性心肌炎中的临床意义。 方法： 选择30例临床确诊为病毒性心肌炎的患儿作为病例组,30例健康儿童作为对照组,检测所有儿童外周血sCD40L和hsCRP的含量,其中病例组患儿治疗2周后再次检测,并将sCD40L和hsCRP含量变化与患儿心肌酶、心电图、心脏解剖等进行对比分析。 结果： 1.病毒性心肌炎患儿治疗前外周血中sCD40L含量(8.10±2.08)ng/ml明显高于对照组(3.85±1.28)ng/ml(P0.05),治疗后无明显下降(P0.05)。 2.病毒性心肌炎患儿治疗前外周血中hsCRP含量(12.42±3.40)mg/L,明显高于对照组(1.80±1.07)mg/L(P0.05),治疗后明显下降(P0.05)。 3.病毒性心肌炎患儿外周血中sCD40L升高者,心肌酶升高、心电图异常、心腔扩大及室壁运动减弱的发生率明显高于sCD40L正常者(P均0.05)。 4.病毒性心肌炎患儿外周血中hsCRP升高者,心肌酶升高、心电图异常、心腔扩大及室壁运动减弱的发生率明显高于hsCRP正常者(P均0.05)。 结论： 1.病毒性心肌炎患儿外周血中sCD40L含量升高,且与患儿心肌酶升高、心电图异常、心腔扩大及室壁运动减弱的发生率相关,表明其在一定程度上能反映病毒性心肌炎的病情。 2.病毒性心肌炎患儿外周血中hsCRP的含量升高,治疗后下降,且与患儿心肌酶升高、心电图异常、心腔扩大及室壁运动减弱的发生率相关,表明hsCRP随病毒性心肌炎患儿的病情和病程而变化,可作为临床辅助诊断指标。
[Abstract]:Objective: The pathogenesis of viral myocarditis has not been fully elucidated. At present, it is considered that the direct damage of virus and the myocardial injury induced by viral infection are the main pathogenesis of viral myocarditis, and T cell mediated immune response plays an important role. CD40-CD40L is an important costimulatory signal molecule, which is a soluble form of CD40L and can bind to CD40 in the costimulatory signal pathway needed for T cell activation. Hypersensitive C-reactive protein (hsCRP) is a low concentration CRP detected by hypersensitivity method, and its sensitivity is higher than that of CRP. The purpose of this study was to investigate the clinical significance of sCD40L and hsCRP in viral myocarditis by detecting the changes of sCD40L and hsCRP in peripheral blood of children with viral myocarditis before and after treatment. Methods: Thirty children with viral myocarditis were selected as the control group and 30 healthy children as the control group. The levels of sCD40L and hsCRP in peripheral blood of all the children were detected again after 2 weeks of treatment. The contents of sCD40L and hsCRP were compared with myocardial enzymes, electrocardiogram and cardiac anatomy. Results: 1. The content of sCD40L in peripheral blood of children with viral myocarditis before treatment was 8.10 卤2.08)ng/ml significantly higher than that of control group (3.85 卤1.28 ng / ml P0.05N). 2. The content of hsCRP in peripheral blood of children with viral myocarditis was 12.42 卤3.40 mg / L before treatment, which was significantly higher than that of control group (1.80 卤1.07g / L), and decreased significantly after treatment. 3. In children with viral myocarditis, the incidence of increased sCD40L, abnormal electrocardiogram, enlarged heart cavity and decreased wall motion in peripheral blood was significantly higher than that in patients with normal sCD40L (P < 0.05). 4. In children with viral myocarditis, the incidence of increased hsCRP, abnormal electrocardiogram, enlarged heart cavity and decreased wall motion in peripheral blood was significantly higher than that in patients with normal hsCRP (P < 0.05). Conclusion: 1. The content of sCD40L in peripheral blood of children with viral myocarditis was increased, which was related to the increase of myocardial enzymes, abnormal electrocardiogram, enlargement of heart cavity and weakening of ventricular wall motion, which indicated that it could reflect the condition of viral myocarditis to a certain extent. 2. The content of hsCRP in peripheral blood of children with viral myocarditis increased and decreased after treatment, and was related to the incidence of myocardial enzymes, abnormal electrocardiogram, dilated heart cavity and decreased wall motion in children with viral myocarditis. The results showed that hsCRP varied with the condition and course of viral myocarditis, and could be used as an auxiliary diagnostic index.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.4

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