NLRP3炎性小体在病毒性心肌炎患者中的水平及临床意义

目的:检测病毒性心肌炎(VMC)患者的核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)炎性小体水平,探讨其临床意义。方法:选择2014年1月~2018年12月入院的170例VMC患者为VMC组,同期50例健康体检者为健康对照组。根据VMC病情严重程度,患者被进一步分为轻度组(60例)、中度组(56例)和重度组(54例)。测量比较各组外周血NLRP3 mRNA、半胱氨酸天冬氨酸蛋白酶(Caspase)-1 mRNA、白介素(IL)-1β和IL-18水平,分析VMC患者外周血单个核细胞(PBMCs)NLRP3 mRNA水平与Caspase-1 mRNA、IL-1β和IL-18水平的相关性,并采用ROC曲线分析NLRP3对VMC严重程度的预测价值。结果:与健康对照组比较,VMC组外周血NLRP3 mRNA[(0.98±0.08)比(2.04±0.25)]、Caspase-1 mRNA[(1.02±0.20)比(1.88±0.31)]、IL-1β[(20.10±5.10)pg/ml比(41.63±6.50)pg/ml]和IL-18[(29.50±6.13)pg/ml比(36.80±8.70)pg/ml]水平均显著升高,P均=0.001。在不同严重程度的VMC亚组间,上述指标水平均符合:轻度组<中度组<重度组,两两比较均有显著差异,P均=0.001。Pearson相关分析显示VMC患者PBMCs NLRP3 mRNA水平与Caspase-1 mRNA、IL-1β和IL-18水平呈显著正相关(r=0.650~0.830,P均=0.001)。ROC曲线分析显示,外周血NLRP3水平的曲线下面积(AUC)为0.885(95%CI 0.806~0.965),最佳工作点(OOP)为1.66NLRP3/GAPDH amol/amol,以此OOP对VMC严重程度进行预测,其敏感性和特异性分别为86.36%和80.00%。结论:外周血NLRP3炎性小体与病毒性心肌炎的发生、发展密切相关,对其病情严重程度的预测,有一定的价值。

NLRP3 inflammasome level in patients with viral myocarditis and its clinical significance

Objective:To measure nucleotide binding oligomerization domain-like receptor protein(NLRP)3 inflammasome level in patients with viral myocarditis(VMC)and its clinical significance.Methods:A total of 170 VMC patients treated in our hospital from Jan 2014 to Dec 2018 were selected as VMC group,another 50 healthy subjects were regarded as healthy control group simultaneously.According to VMC severity,patients were further divided into mild group(n=60),moderate group(n=56)and severe group(n=54).Peripheral blood levels of NLRP3 mRNA,Caspase-1 mRNA,interleukin(IL)-1βand IL-18 were measured and compared among all groups,correlation among peripheral blood mononuclear cells(PBMCs)NLRP3 mRNA,Caspase-1 mRNA,IL-1βand IL-18 levels were analyzed.ROC curve was used to analyze predictive value of NLRP3 for VMC severity.Results:Compared with healthy control group,there were significant rise in levels of peripheral blood NLRP3 mRNA[(0.98±0.08)vs.(2.04±0.25)],Caspase-1 mRNA[(1.02±0.20)vs.(1.88±0.31)],IL-1β[(20.10±5.10)pg/ml vs.(41.63±6.50)pg/ml]and IL-18[(29.50±6.13)pg/ml vs.(36.80±8.70)pg/ml]in VMC group,P=0.001 all.Among VMC subgroups with different severity,all above indexes were accorded with:mild group