慢性心力衰竭儿童血清PTX-3、syndecan-4水平变化及意义

Change of serum levels of pentraxin-3 and syndecan-4 in children with chronic heart failure

摘要:

目的 探讨血清pentraxin-3（PTX-3）、syndecan-4在儿童慢性心力衰竭（chronic heart failure，CHF）中的变化及意义。方法 选取收治的CHF患儿40例为心衰组，另选取同期门诊健康体检儿童30例为对照组。分别测定并比较血清PTX-3、syndecan-4、氨基末端脑钠肽前体（N-terminal pro-B-type natriuretic peptide，NT-proBNP）水平。结果 心衰组患儿治疗前血清PTX-3、syndecan-4、NT-proBNP浓度均高于治疗后及对照组，且治疗后亦高于对照组（P < 0.05）；PTX-3、syndecan-4在心功能Ⅱ、Ⅲ、Ⅳ级组患儿中均高于对照组（P < 0.05）；心功能Ⅳ级组与心功能Ⅱ级组相比，PTX-3、syndecan-4浓度明显升高（P < 0.05）。心衰组患儿治疗前血清PTX-3与syndecan-4水平呈正相关（r_s=0.999，P < 0.05）；血清PTX-3水平与NT-proBNP、左心室质量指数、心功能分级呈正相关（分别r_s=0.726、0.736、0.934，P < 0.05），与左室射血分数、左室短轴缩短率呈负相关（分别r_s=-0.852、-0.767，P < 0.05）；血清syndecan-4水平与NT-proBNP、左心室质量指数、心功能分级呈正相关（分别r_s=0.733、0.743、0.934，P < 0.05），与左室射血分数、左室短轴缩短率呈负相关（分别r_s=-0.856、-0.771，P < 0.05）。结论 血清PTX-3、syndecan-4可能参与CHF患儿心室重塑的发生发展，血清PTX-3、syndecan-4可能为儿童心力衰竭的诊断、心功能分级及治疗效果提供参考价值。

Abstract:

Objective To study the change and significance of serum pentraxin-3 (PTX-3) and syndecan-4 in children with chronic heart failure (CHF). Methods A total of 40 children with CHF who were admitted to the Department of Pediatrics of the First Affiliated Hospital of Zhengzhou University were enrolled as the heart failure group, and 30 children who underwent physical examination in the outpatient service during the same period of time were enrolled as the control group. The serum levels of PTX-3, syndecan-4, and N-terminal pro-brain natriuretic peptide (NT-proBNP) were compared between the two groups. Results The children with CHF had significant reductions in the serum levels of PTX-3, syndecan-4, and NT-proBNP after treatment. The levels of these markers in children with CHF were significantly higher than the control group before and after treatment (P < 0.05). The CHF children with grade II/III/IV cardiac function had significantly higher serum levels of PTX-3 and syndecan-4 than the control group (P < 0.05). The levels of PTX-3 and syndecan-4 were related to the severity of cardiac function. Compared with the grade II cardiac function group, the grade IV cardiac function group had significant increases in the serum levels of PTX-3 and syndecan-4 (P < 0.05). The serum level of PTX-3 was positively correlated with that of syndecan-4 in children with CHF (rs=0.999, P < 0.05); the serum level of PTX-3 was positively correlated with NT-proBNP, left ventricular mass index (LVMI), and cardiac function grade (rs=0.726, 0.736, and 0.934 respectively, P < 0.05) and was negatively correlated with left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) (rs=-0.852 and -0.767 respectively, P < 0.05); the serum level of syndecan-4 was positively correlated with NT-proBNP, LVMI, and cardiac function grade (rs=0.733, 0.743, and 0.934 respectively, P < 0.05) and was negatively correlated with LVEF and LVFS (rs=-0.856 and -0.771 respectively, P < 0.05). Conclusions Serum PTX-3 and syndecan-4 may be involved in the development and progression of ventricular remodeling in children with CHF and may be used as markers for the diagnosis, cardiac function grading, and treatment outcome evaluation of children with heart failure.