白细胞介素-6与左心衰竭所致肺动脉高压的相关性及预测价值

Correlation and predictive value of interleukin-6 with pulmonary hypertension caused by left heart disease

目的探讨左心疾病所致肺动脉高压(pulmonary hypertension caused with left heart disease,PH-LHD)患者血清白细胞介素-6(interleukin-6,IL-6)水平及其预测价值。方法选取2019年10月至2021年3月于聊城市人民医院或聊城市第三人民医院住院被诊断为左心衰竭的225例患者作为研究对象,其中PH-LHD患者157例。采用多元线性回归分析各因素与PH-LHD的相关性。采用多因素Cox比例风险回归模型分析出现PH-LHD的危险因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析IL-6对PH-LHD的预测价值。结果PH-LHD患者占69.78%(157/225),根据跟着指南走—心力衰竭(get with the guidelines-heart failure,GWTG-HF)模型评分将PH-LHD患者分为低危组60例(GWTG-HF评分≤35分)、中危组77例(GWTG-HF评分>35~41分)与高危组20例(GWTG-HF评分>41分)。低危、中危和高危组IL-6水平依次升高,分别为17.71(14.51,25.01)、26.92(16.76,43.57)、60.30(34.00,105.43)pg/mL,差异有统计学意义(P<0.05)。线性回归分析结果显示,血清IL-6与PH-LHD患者GWTG-HF评分存在显著相关性(t=7.985,P<0.01)。Cox回归分析结果显示,红细胞分布宽度(red blood cell distribution width,RDW)、血尿素氮、N端脑钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-proBNP)、IL-6是PH-LHD的独立预测因素(P<0.05),ROC曲线分析进一步显示了血清IL-6对PH-LHD独立预测的优越性[曲线下面积(area under curve,AUC)为0.916,95%CI 0.910~0.972,临界值为13.43 pg/mL,灵敏度为92.81%,特异度为85.32%]。结论血清IL-6可作为PH-LHD患者疾病风险评估的依据,对PH-LHD具有较好的独立预测价值。

Objective To determine the serum interleukin-6(IL-6)level and predictive value in patients with pulmonary hypertension caused by left heart disease(PH-LHD).Methods A total of 225 patients diagnosed with left heart failure between October 2019 and March 2021 were included in the current study,including 157 patients diagnosed with PH-LHD.Multiple linear regression was used to analyze the correlation between each factor and PH-LHD.Multivariate Cox proportional hazard regression model was used to analyze the risk factors for PH-LHD.The IL-6 predictive value for PH-LHD was analyzed using a receiver operating characteristic(ROC)curve.Results Of the 225 patients with LHD,157(69.78%)were complicated by PH.According to the Get With The Guidelines-Heart Failure(GWTG-HF)model score,PH-LHD patients were divided into a low-risk group of 60(GWTG-HF score,≤35 points),a medium-risk group of 77(GWTG-HF score,>35-41 points),and a high-risk group of 20(GWTG-HF score,>41 points).The IL-6 levels in each group increased as the GWTF-HF score increased[17.71(14.51,25.01),26.92(16.76,43.57),and 60.30(34.00,105.43)pg/mL,respectively;P<0.05].Linear regression analysis showed that serum IL-6 was significantly correlated with the GWTG-HF score(t=7.985,P<0.01).Cox regression analysis showed that red cell volume distribution width,blood urea nitrogen,N-terminal pro-B-type natriuretic peptide,and IL-6 were independent predictors of PH-LHD(P<0.05).ROC curve analysis further showed the superiority of serum IL-6 as an independent predictor of PH-LHD(area under the curve,0.916;95%CI 0.910~0.972;critical value,13.43 pg/mL;sensitivity,92.81%;specificity,85.32%).Conclusions Serum IL-6 can be used as the basis for disease risk assessment in PH-LHD patients.Moreover,serum IL-6 has good independent predictive value for PH-LHD patients.