Hcy Ang-(1-7)在先天性心脏病伴肺动脉高压患者血清中的表达及临床价值

Expression and clinical significance of serum Hcy and Ang-(1-7)in patients with congenital heart disease and pulmonary arterial hypertension

目的探讨同型半胱氨酸、血管紧张素-(1-7)在先天性心脏病伴肺动脉高压患者血清中的表达及临床价值。方法将70例左向右分流型先天性心脏病患者设为研究组,70名体检健康者设为对照组,检测两组血清同型半胱氨酸、血管紧张素-(1-7)水平及平均肺动脉压力、肺动脉收缩压。按平均肺动脉压力将研究组分为3个亚组(无PAH组、轻度组、重度组),比较3个亚组上述指标差异。采用受试者工作特征曲线分析血清同型半胱氨酸、血管紧张素-(1-7)水平对先天性心脏病伴肺动脉高压的诊断价值。结果研究组血清同型半胱氨酸、血管紧张素-(1-7)水平显著高于对照组(P<0.01)。3个亚组血清同型半胱氨酸、血管紧张素-(1-7)水平及平均肺动脉压力、肺动脉收缩压比较差异有统计学意义(P<0.01),重度组显著高于轻度组、无PAH组(P<0.01),轻度组显著高于无PAH组(P<0.01)。Spearman相关分析显示,研究组血清同型半胱氨酸、血管紧张素-(1-7)水平与平均肺动脉压力、肺动脉收缩压呈显著正相关(P<0.05或0.01)。受试者工作特征曲线显示,血清同型半胱氨酸、血管紧张素-(1-7)联合诊断先天性心脏病的曲线下面积为0.911,高于单独检测,二者联合检测的敏感度为88.9%,特异度为92.2%。结论先天性心脏病伴肺动脉高压患者血清同型半胱氨酸、血管紧张素-(1-7)水平异常升高,与平均肺动脉压力、肺动脉收缩压呈正相关,二者联合检测有助于先天性心脏病伴肺动脉高压的诊断。

Objective To explore expression and clinical significance of serum homocysteine(Hcy)and angiotensin-(1-7)[Ang-(1-7)]in patients with congenital heart disease(CHD)and pulmonary arterial hypertension(PAH).Methods A total of 70 CHD patients of left to right shunt type were seen as the study group,and 70 healthy people with physical examination were seen as the control group.The levels of serum Hcy,Ang-(1-7),mean pulmonary artery pressure(MPAP)and pulmonary artery systolic pressure(PASP)were detected in the two groups.According to the MPAP,the study group was divided into 3 subgroups(non-PAH group,mild group,severe group),and the differences in the above indicators of the 3 subgroups were compared.The receiver operating characteristic curve was used to analyze the diagnostic value of serum Hcy and Ang-(1-7)levels for congenital heart disease with pulmonary hypertension.Results The serum levels of Hcy and Ang-(1-7)in the study group were significantly higher than those in the control group(P<0.01).There were statistically significant differences in serum Hcy,Ang-(1-7)levels and MPAP and PASP among the three subgroups(P<0.01).The severe group was significantly higher than the mild group and the non-PAH group(P<0.01),and the mild group was significantly higher than the non-PAH group(P<0.01).Spearman correlation analysis showed that serum Hcy and Ang-(1-7)levels in the study group were significantly positively correlated with MPAP and PASP(P<0.05 or 0.01).The receiver operating characteristic curve showed that the area under the curve for the combined diagnosis of congenital heart disease by serum Hcy and Ang-(1-7)was 0.911,which was higher than that of the single detection.The sensitivity of the combined detection of the two was 88.9%and the specificity was 92.2%.Conclusions The levels of serum Hcy and Ang-(1-7)in CHD-PAH patients are abnormally increased,which are positively correlated with MPAP and PASP.The combined detection of the two is helpful for the diagnosis of congenital heart disease with pulmonary hypertension.