Relationship between the serum levels of APE1 and YB-1 and the severity and prognosis of viral myocarditis in chil-dren

Li Xin; He Bihai; Zhang Nini; Shi Nannan; Liu Yun; Song Caihong; He Zhaoping

doi:10.3969/j.issn.1671-6450.2024.12.006

Abstract：Objective To investigate the relationship between serum apurinic/apyrimidinic endonuclease 1(APE1),Y-box binding protein 1(YB-1)levels and the severity and prognosis of children with viral myocarditis(VMC).Methods One hundred and fifty-two children with VMC admitted to the Department of Pediatrics in Yulin Hospital,the First Affiliated Hospital of Xi'an Jiaotong University from May 2022 to May 2023 were selected as the VMC group,according to the prog-nosis of the children after 1 year of follow-up,they were divided into poor prognosis subgroup(n=43)and good prognosis subgroup(n=109).A total of 113 healthy children in the same period were selected as the healthy control group.Serum levels of APE1 and YB-1 were measured by enzyme-linked immunosorbent assay.Pearson correlation analysis was used to analyze the correlation between serum APE1,YB-1 levels and differential indicators.Multivariate Logistic regression analysis was used to analyze the influencing factors of poor prognosis in children with VMC.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum APE1 and YB-1 levels for poor prognosis in children with VMC.Results The levels of serum APE1 and YB-1 in VMC group were lower than those in healthy control group(t/P=35.472/＜0.001;25.388/＜0.001).After 1 year of follow-up,the incidence of poor prognosis in 152 children with VMC was 2829％(43/152).LVEF,APE1 and YB-1 in the poor prognosis subgroup were lower than those in the good prognosis sub-group(t/P=8.878/＜0.001;26.085/＜0.001;14.180/＜0.001),and cTnI was higher than that in the good prognosis subgroup(t/P=2.630/0.009).Pearson correlation analysis showed that APE1 and YB-1 were negatively correlated with cTnI and CK-MB,respectively,and positively correlated with LVEF(APEl:r/P=-0.575/＜0.001,-0.426/0.008,0.591/＜0.001;YB-l:r/P=-0.589/＜0.001,-0.417/0.011,0.609/＜0.001).Multivariate Logistic regression results showed that low LVEF,low APE1 and low YB-1 were independent risk factors for poor prognosis in children with VMC[OR(95％CI)=3.967(1.246-12.634)、4.778(1.728-13214)、4.914(1.851-13.041)].The area under the curve(AUC)of serum APE1,YB-1 levels and their combination in pre-dicting poor prognosis of children with VMC were 0.704,0.680 and 0.897,respectively,and the AUC of their combination was greater than that of serum APE1 and YB-1 levels alone(Z/P=4.233/＜0.001;4.328/＜0.001).Conclusion Serum APE1 and YB-1 levels in children with VMC can reflect myocardial injury and cardiac function.The combined diagnosis of APE1 and YB-1 can significantly improve the predictive efficacy of poor prognosis in children with VMC,and provide a sufficient basis for clinical intervention.