检测疱疹性咽峡炎患儿血清生长分化因子-15（GDF-15）和肽素水平，探究其与患儿发生心肌损伤的相关性。

选取2016年1月至2019年1月广元市中医医院收治疱疹性咽峡炎患儿398例为研究对象，其中单纯疱疹性咽峡炎患儿214例（对照组），疱疹性咽峡炎合并心肌损伤患儿184例（观察组）。采集所有受试者外周静脉血，常规分离血清，采用酶联免疫吸附法检测血清GDF-15、肽素水平及心肌损伤标志物心肌肌钙蛋白Ⅰ（cTnⅠ）水平，采用DXC600全自动生化仪检测血清磷酸肌酸激酶（CK）和酸激酶同工酶（CK-MB）水平。采用Pearson法分析血清GDF-15、肽素与CK-MB、cTnⅠ的相关性；采用Logistic回归分析影响疱疹性咽峡炎患儿并发心肌损伤的危险因素；绘制受试者工作特性曲线（ROC）分析血清GDF-15、肽素与CK-MB、cTnI水平对疱疹性咽峡炎患儿发生心肌损伤的诊断价值。

观察组与对照组患儿性别、年龄和病程差异无统计学意义（χ² = 0.672，t = 0.585、0.576，P均> 0.05）；与对照组比较，观察组患儿白细胞（WBC）、中性粒细胞（GRAN）及血清超敏C-反应蛋白（hs-CRP）、GDF-15、肽素、CK、CK-MB和cTnⅠ水平显著升高，心电图异常比例显著增加，差异均有统计学意义（t = 21.237、18.324、33.084、13.535、17.192、21.859、39.014、24.369，χ² = 28.097，P均< 0.05）。Pearson法相关性分析显示，疱疹性咽峡炎合并心肌损伤患儿血清GDF-15、肽素与CK-MB、cTnⅠ水平分别呈正相关（r = 0.530、0.427、0.443、0.440，P均< 0.05）。血清GDF-15、肽素、CK-MB和cTnⅠ水平升高均为影响疱疹性咽峡炎患儿发生心肌损伤的独立危险因素（P均< 0.05）。血清GDF-15、肽素、CK-MB和cTnⅠ水平诊断疱疹性咽峡炎患儿心肌损伤的曲下面积（AUC）分别为0.862、0.894、0.886和0.973，灵敏度分别为81.10%、84.20%、85.30%和90.20%，特异度分别为79.00%、81.30%、91.40%和94.90%，血清GDF-15、肽素联合检测的AUC为0.953，灵敏度为94.60%，特异度为84.10%。

疱疹性咽峡炎患儿血清GDF-15和肽素水平显著升高，与心肌损伤标志物CK-MB、cTnⅠ蛋白水平呈正相关，是影响疱疹性咽峡炎患儿发生心肌损伤的独立危险因素，二者联合检测可能对诊断疱疹性咽峡炎合并心肌损伤有一定参考价值。

To investigate the levels of serum growth differentiation factor-15 (GDF-15), copeptin and myocardial damage markers, and to explore their correlation with myocardial damage in children with herpes angina.

Total of 398 children with herpes angina were collected from January 2016 to January 2019, among whom, 214 children were with herpes simplex angina (control group) and 184 children with herpes angina complicated with myocardial damage (observation group). Peripheral venous blood was collected from all subjects and serum was separated routinely, levels of serum GDF-15, copeptin and marker of myocardial damage cardiac troponinⅠ(cTnⅠ) were measured by ELISA, and levels of serum creatine kinase (CK) and kinase isoenzyme (CK-MB) were measured by DXC600 automatic biochemical analyzer. Pearson correlation analysis was used to analyze the correlations between serum GDF-15, copeptin and CK-MB, cTnⅠ, and Logistic regression analysis was used to analyze the risk factors of myocardial damage in children with herpetic angina. The diagnostic values of serum GDF-15, copeptin, CK-MB and cTnⅠ levels on myocardial damage in children with herpetic pharyngitis were tested by ROC.

There was no significant differences in gender, age and course of disease between cases in observation group and control group (χ² = 0.672, t = 0.585, 0.576; all P > 0.05). Compared with cases in control group, white blood cell (WBC), neutrophile granulocyte (GRAN) and the levels of serum high sensitive C reaction protein (hs-CRP), GDF-15, copeptin, CK, CK-MB and cTnⅠ in observation group increased significantly, while the proportion of abnormal ECG increased significantly (t = 21.237, 18.324, 33.084, 13.535, 17.192, 21.859, 39.014, 24.369, χ² = 28.097; all P < 0.05). Pearson correlation analysis showed that the levels of serum GDF-15, copeptin and CK-MB, cTnⅠ were positively correlated of children of herpes angina complicated with myocardial damage, respectively (r = 0.530, 0.427, 0.443, 0.440; all P < 0.05). Increases of levels of serum GDF-15, copeptin, CK-MB and cTnⅠ were independent risk factors for myocardial damage of children with herpetic angina (all P < 0.05). Serum GDF-15, copeptin, CK-MB and cTnⅠ levels were used to diagnose the myocardial damage of children with herpetic angina, and the area of under curve (AUC) were 0.862, 0.894, 0.886 and 0.973, respectively, and the sensitivity were 81.10%, 84.20%, 85.30% and 90.20%, respectively, the specificity was 79.00%, 81.30%, 91.40% and 94.90%, respectively. The AUC of serum GDF-15 combined with copeptin was 0.953, sensitivity was 94.60% and specificity was 84.10%.

The levels of serum GDF-15 and copeptin of children with herpetic angina were significantly increased, which were positively correlated with levels of CK-MB and cTnⅠ proteins, and were independent risk factors for myocardial damage of children with herpetic angina, which may be of some reference value to diagnose myocardial damage.