吲哚胺2,3-双加氧酶作为小儿先天性心脏病术后全身炎症反应综合征诊断标志物的价值

Value of indoleamine 2,3-dioxygenase in diagnosis of systemic inflammatory response syndrome after cardiopulmonary bypass in children with congenital heart disease

摘要:

目的 探讨吲哚胺2，3-双加氧酶（IDO）作为小儿先天性心脏病（简称先心病）体外循环术后全身炎性反应综合征（SIRS）早期诊断标志物的价值。方法 选取2012年5月至2016年1月行体外循环手术的先心病患儿90例，按照术后是否发生SIRS分为SIRS组（n=43）和对照组（未发生SIRS，n=47）。收集患儿术前、术中、术后不同时间点外周血，测定并比较两组血清IDO、白细胞介素-6（IL-6）、C-反应蛋白（CRP）浓度。利用ROC曲线分析各指标的诊断效能。结果 SIRS组血清CRP水平在术后72 h，IL-6水平在转机中及术后72 h高于对照组；血清IDO水平在术后24 h及72 h高于对照组。IDO在术后24 h对SIRS有诊断意义，其ROC曲线下面积为0.793，特异性为100%，敏感性为58.14%。CRP、IL-6及IDO在术后72 h对SIRS均有诊断意义，其中IDO诊断效能最高，其ROC曲线下面积为0.927，特异性为95.74%，敏感性为76.74%。结论 小儿先心病术后IL-6、CRP及IDO对诊断SIRS均有一定意义，其中IDO诊断效能最高，可更早、更准确预测小儿先心病术后SIRS的发生。

Abstract:

Objective To study the value of indoleamine 2,3-dioxygenase (IDO) in the early diagnosis of systemic inflammatory response syndrome (SIRS) after cardiopulmonary bypass in children with congenital heart disease.Methods A total of 90 children with congenital heart disease who underwent cardiopumonary bypass surgery between May 2012 and January 2016 were enrolled. According to the prsence or absence of SIRS after surgery, they were divided into SIRS group (n=43) and control group (n=47). Peripheral blood samples were collected before surgery, during surgery, and after surgery. Serum levels of IDO, C-reactive protein (CRP), and interleukin-6 (IL-6) were measured and compared between the two groups. The receiver operating characteristic (ROC) curve was used to evaluate their diagnostic efficiency.Results Compared with the control group, the SIRS group had higher serum CRP levels at 72 hours after surgery, higher IL-6 levels during surgery and at 72 hours after surgery, and higher IDO levels at 24 and 72 hours after surgery. IDO had a certain value in the diagnosis of SIRS at 24 hours after surgery with an area under the ROC curve (AUC) of 0.793, a specificity of 100%, and a sensitivity of 58.14%. CRP, IL-6, and IDO had a certain value in the diagnosis of SIRS at 72 hours after surgery. IDO had the highest diagnostic efficiency with an AUC of 0.927, a specificity of 95.74%, and a sensitivity of 76.74% at 72 hours after surgery.Conclusions IL-6, CRP, and IDO have a certain value in the diagnosis of SIRS after surgery for congenital heart disease, and IDO has a higher diagnostic efficiency. IDO can predict the development of SIRS in children after surgery for congenital heart disease earlier.