Expression And Clinical Value Of Apelin In Eripheal Blood Of Children With Sepsis Myocardial Injury

Objective:By detecting the concentration of Apelin in serum of children with sepsis and myocardial injury,the expression of Apelin in serum of children with sepsis and myocardial injury was analyzed,in order to find new markers of myocardial injury caused by sepsis,and to guide clinical diagnosis and treatment.Method:Forty-six children with sepsis hospitalized in the Children's Hospital Affiliated to Soochow University from June 2018 to February 2019 were selected as prospective subjects.According to the existence of abnormal myocardial enzymes,sepsis children were divided into myocardial injury group and non-myocardial injury group.At the same time,Twenty-four children without clinical signs of infection were taken as control group who were admitted to our urology department for circumcision and hernioplasty and no recent infection occurred in the children.(1)The expression levels of interleukin-6(IL-6),interleukin-8(IL-8),interleukin-10(IL-10),interleukin-1?(IL-1?)and Tumor Necrosis Factor(TNF)in serum were detected by flow cytometry and compared.(2)The serum concentrations of Apelin was detect by enzyme-linked immunosorbent assay(ELISA)and was compared in three groups of children.(3)General clinical data and laboratory examinations of three groups were collected and analyzed,including gender,age,heart rate,fever days and levels of peripheral white blood cell count,C-reaction protein(CRP),lactate dehydrogenase(LDH),alanine aminotransferase(ALT),creatinine and human serum albumin(HSA)at admission.Results:First,comparison of general clinical data and laboratory examination results:?There was no significant difference in sex and age among the three groups(P>0.05),but there was significant difference in fever days and heart rate among the three groups(P<0.05).The fever days in sepsis myocardial injury group were significantly fewer than those in sepsis without myocardial injury group(P<0.05),while those in sepsis myocardial injury group were more than those in control group(P<0.05).The fever days in sepsis without myocardial injury group were significantly more than those in control group(P<0.05).There was no significant difference in heart rate between sepsis myocardial injury group and sepsis non-myocardial injury group(P>0.05);heart rate of sepsis myocardial injury group and non-myocardial injury group was significantly higher than that of control group(P<0.05).?There was no significant difference in alanine aminotransferase and creatinine levels among the three groups(P>0.05).There were significant differences in peripheral blood leukocyte count,CRP,LDH and HSA levels among the three groups(P<0.001).There was no significant difference in peripheral white blood cell count,CRP,LDH and HSA levels between sepsis myocardial injury group and sepsis non-myocardial injury group(P>0.05).The levels of peripheral white blood cells,CRP and LDH in sepsis myocardial injury group and sepsis non-myocardial injury group were higher than those in control group(P<0.05),and the levels of HSA were lower than those in control group(P<0.05).Second,comparison of serum levels of inflammatory factors:?The levels of IL-6,IL-8,IL-10,IL-1? and TNF in serum were significantly different among the three groups(P<0.05).?The expression levels of IL-10 and TNF in sepsis myocardial injury group were higher than those in sepsis non-myocardial injury group(P<0.05),and the expression levels of IL-6,IL-8,IL-10,IL-1? and TNF in sepsis myocardial injury group were higher than those in control group(P<0.05).?The expression levels of IL-6,IL-8,IL-10 and IL-1?in sepsis group without myocardial injury were higher than those in control group(P<0.05).Third,comparison of serum Apelin concentration:?The serum Apelin concentration in sepsis myocardial injury group was significantly higher than that in sepsis non-myocardial injury group and control group(P<0.05).?The serum Apelin concentration in sepsis without myocardial injury group was significantly higher than that in control group(P<0.05).Fourth,analysis of correlation between serum Apelin concentration and clinical data and related inflammatory factors:?Serum Apelin concentration was positively correlated with fever days,CRP,LDH,IL-6,IL-8,IL-10 and IL-1?(P<0.05).?Stepwise multiple linear regression analysis showed that IL-1? and LDH were the factors influencing Apelin concentration in serum(P<0.05),which might increase Apelin concentration in serum.Fifth,evaluation of predictive efficacy of serum Apelin concentration on sepsis-induced myocardial injury:?Multivariate Logistic regression analysis showed that Apelin was a related factor affecting sepsis-induced myocardial injury(OR=12.353,95%CI:1.361-112.152).?The receiver operating characteristic curve(ROC)of Apelin and sepsis-induced myocardial injury showed that the area under the curve(AUC)was 0.731,the truncation value was 1.418,the sensitivity was 50.00%,and the specificity was 92.30%.Conclusion:(1)The serum levels of IL-10 and TNF in children with sepsis myocardial injury were higher than those in children without sepsis myocardial injury,suggesting that IL-10 and TNF are related to sepsis-induced myocardial injury.(2)The expression level of Apelin in serum of children with sepsis-induced myocardial injury was significantly higher than that of children without sepsis-induced myocardial injury and non-sepsis-induced myocardial injury,indicating that Apelin participated in sepsis and the process of myocardial injury caused by sepsis.(3)Serum Apelin concentration is a related factor of myocardial injury caused by sepsis,and may be one of the predictive indicators of myocardial injury caused by sepsis.