Ozde Sukriye, Mehdizade Cansu, Ali Ozel Mehmet, Ozde Cem, Kayapinar Osman, Erguven Muferret
Department of General Pediatric, Faculty of Medicine, Duzce University, 81620 Duzce, Turkey.
Department of Radiology, Faculty of Medicine, Duzce University, 81620 Duzce, Turkey.
Diagnostics (Basel). 2025 Apr 24;15(9):1077. doi: 10.3390/diagnostics15091077.
: It has been suggested that chronic inflammatory diseases may be associated with an increased risk of cardiovascular disease. In this study, we investigated plasma soluble CD40 ligand (sCD40L) levels and their association with carotid intima-media thickness (cIMT) in children with Familial Mediterranean fever (FMF). : The study was designed as a prospective cross-sectional study. The study included 68 asymptomatic children aged 5-18 years with FMF, diagnosed according to Tel Hashomer criteria, who were followed up regularly for at least one year, receiving regular colchicine treatment and not in an acute exacerbation period, along with 65 healthy children with similar demographic characteristics. cIMT was assessed by ultrasound and plasma sCD40L levels were measured by sandwich ELISA in all children. : Erythrocyte sedimentation rate, high-sensitivity C-reactive protein and serum amyloid A levels were not significantly different between patients and controls. However, sCD40L ( = 0.004) and fibrinogen ( = 0.011) levels were significantly higher in the FMF group compared to the control group. No significant difference was found between the patient and control groups in terms of carotid intima-media thickness ( = 0.517). Multivariate logistic regression was performed to assess the independent associations of fibrinogen and sCD40L with FMF. The results of this analysis indicated that sCD40L, but not fibrinogen, demonstrated a significant association with FMF (odds ratio [OR]: 1.003, 95% confidence interval [CI]: 1.001-1.006, = 0.011). To determine the diagnostic performance of sCD40L, a receiver operating characteristic (ROC) curve was generated. This analysis demonstrated that sCD40L levels exceeding 100 pg/mL were predictive of FMF, yielding a sensitivity of 70.6% and a specificity of 62.3%. The positive predictive value and negative predictive value were 55.4% and 64.3%, respectively. The area under the curve for sCD40L was 0.644 (95% CI: 0.549-0.738, = 0.004), signifying a statistically significant predictive capacity. Plasma sCD40L levels were significantly higher in FMF children with the M694V mutation ( = 0.013). : The results of this study suggest that the high plasma sCD40L levels found in children with FMF may be related to the inflammatory activation of the disease rather than to atherosclerosis.
有人提出，慢性炎症性疾病可能与心血管疾病风险增加有关。在本研究中，我们调查了家族性地中海热（FMF）患儿的血浆可溶性CD40配体（sCD40L）水平及其与颈动脉内膜中层厚度（cIMT）的关系。
本研究设计为前瞻性横断面研究。该研究纳入了68名年龄在5至18岁之间、根据泰尔哈绍默标准诊断为FMF的无症状患儿，他们至少接受了一年的定期随访，接受常规秋水仙碱治疗且不在急性加重期，同时纳入了65名具有相似人口统计学特征的健康儿童。所有儿童均通过超声评估cIMT，并通过夹心ELISA法测量血浆sCD40L水平。
患者和对照组之间的红细胞沉降率、高敏C反应蛋白和血清淀粉样蛋白A水平无显著差异。然而，FMF组的sCD40L（P = 0.004）和纤维蛋白原（P = 0.011）水平显著高于对照组。患者组和对照组在颈动脉内膜中层厚度方面无显著差异（P = 0.517）。进行多变量逻辑回归以评估纤维蛋白原和sCD40L与FMF的独立关联。该分析结果表明，与FMF有显著关联的是sCD40L而非纤维蛋白原（比值比[OR]：1.003，95%置信区间[CI]：1.001 - 1.006，P = 0.011）。为了确定sCD40L的诊断性能，绘制了受试者工作特征（ROC）曲线。该分析表明，sCD40L水平超过100 pg/mL可预测FMF，敏感性为70.6%，特异性为62.3%。阳性预测值和阴性预测值分别为55.4%和64.3%。sCD40L的曲线下面积为0.644（95%CI：0.549 - 0.738，P = 0.004），表明具有统计学显著的预测能力。携带M694V突变的FMF患儿血浆sCD40L水平显著更高（P = 0.013）。
本研究结果表明，FMF患儿中发现的高血浆sCD40L水平可能与疾病的炎症激活有关，而非与动脉粥样硬化有关。
