左心疾病相关性肺高压患者血清sCD137水平及临床意义

Levels and clinical implication of serum soluble CD137 in patients with pulmonary hypertension due to left heart disease

目的:检测左心疾病相关性肺高压(PH-LHD)患者血清可溶性CD137(sCD137)的水平并探讨其临床意义。方法:收集76例左心疾病(LHD)患者的临床资料,以肺动脉收缩压(PASP)≥40 mmHg(1 mmHg=0.133 kPa)作为肺高压(PH)的诊断依据,其中单纯LHD患者40例(LHD组),LHD合并PH患者36例(PH-LHD组),对照组为30例体检健康的成年人。血清sCD137水平采用ELISA法检测。结果:PH-LHD组血清sCD137水平高于LHD组和对照组,3组的血清sCD137水平分别为9.27(7.01,13.71)pg/ml、6.68(4.26,8.26)pg/ml、2.52(1.22,3.22)pg/ml,组间比较差异均有统计学意义(P<0.05)。相关性分析显示PH-LHD组血清sCD137水平与血肌酐、血浆B型尿钠肽(BNP)、左房内径(LAD)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)及PASP正相关,与左室射血分数(LVEF)呈负相关。Logistic回归分析显示,sCD137为PH-LHD的独立影响因素之一(P<0.05)。sCD137预测PH-LHD的受试者工作特征曲线下面积(AUC)为0.722(95%CI:0.607~0.837,P=0.001),最佳阈值为>8.22 pg/ml,敏感性为0.611,特异性为0.750,当联合BNP及三酰甘油/高密度脂蛋白胆固醇(TG/HDL-C)后预测PH-LHD的AUC为0.910(95%CI:0.841~0.980,P<0.001),最佳阈值为>0.53,敏感性为0.778,特异性为0.950。结论:PH-LHD患者血清sCD137水平较LHD患者升高,提示sCD137可能参与PH-LHD的发生发展。血清sCD137对LHD患者发生PH-LHD有一定预测价值,联合BNP及TG/HDL-C对PH-LHD的预测效果更佳。

Objective:The aim of the present study was to investigate the levels of serum soluble CD137(sCD137)in patients with pulmonary hypertension due to left heart disease(PH-LHD)and explore it’s clinical significance.Method:The clinical data of 76 patients with LHD were collected,and PH was defined by pulmonary artery systolic pressure(PASP)≥40 mmHg,including 40 patients with LHD(LHD group)and 36 patients with PH-LHD(PH-LHD group),30 healthy adults served as control group.Enzyme-linked immunosorbent assay(ELISA)was used to determine the levels of sCD137 in serum.Result:The levels of serum sCD137 in PH-LHD group was higher than that in LHD group and healthy control group.Serum sCD137 in three groups were 9.27(7.01,13.71)pg/ml,6.68(4.26,8.26)pg/ml and 2.52(1.22,3.22)pg/ml,in respectively.The differences were statistically significant(P<0.05)Serum sCD137 levels were positively correlated with serum creatinine,brain natriuretic peptide,left atrial diameter,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,and PASP,and negatively correlated with left ventricular ejection fraction.Logistic regression analysis showed that sCD137 was one of the independent influencing factors of PH-LHD(P<0.05).Receiver operating characteristic curves showed that the area under the curve(AUC)of sCD137 was 0.722(95%CI:0.607-0.837,P=0.001)in the prediction of PH-LHD,the cut-off value was>8.22 pg/ml,with the sensitivity at 0.611,specificity at 0.750.When combined with BNP and TG/HDL-C,the AUC of predicting PH-LHD was 0.910(95%CI:0.841-0.980,P<0.001),the cut-off value was>0.53,with the sensitivity at 0.778,specificity at 0.950.Conclusion:The serum sCD137 levels in patients with PH-LHD was higher than that in patients with LHD,suggesting that sCD137 may participate in the occurrence and development of PH-LHD.A certain value was showed in sCD137 of predicting the occurrence of PH-LHD in LHD patients which was better when combined with BNP and TG/HDL-C.