sST-2、GDF-15和NLR在慢性阻塞性肺疾病相关肺动脉高压发生预后不良中的诊断价值

Diagnostic value of sST-2,GDF-15 and NLR in poor prognosis of pulmonary hypertension associated with chronic obstructive pulmonary disease

目的观察血清可溶性致瘤因子-2(sST-2)、生长分化因子-15(GDF-15)和中性粒细胞/淋巴细胞比值(NLR)在慢性阻塞性肺疾病(COPD)相关肺动脉高压(PH)发生预后不良中的诊断效能。方法选取2020年1月至2021年12月在上海市浦东新区公利医院诊断为COPD合并PH的121例患者作为COPD合并PH组,根据COPD合并PH患者预后情况又分为预后良好组(93例)和预后不良组(28例);另选取同期75例单纯COPD患者作为COPD组,45例健康体检者作为健康对照组。比较各组血清sST-2、GDF-15水平和NLR,COPD合并PH影响预后的多因素分析,血清sST-2、GDF-15水平和NLR与COPD合并PH严重程度的关系及对COPD合并PH发生预后不良的诊断价值。结果COPD合并PH组血清sST-2、GDF-15水平和NLR均明显高于COPD组和健康对照组,COPD组明显高于健康对照组,差异均有统计学意义(P<0.05),并且随着PH严重程度升高而升高。预后良好组左室射血分数(LVEF)水平明显高于预后不良组,而预后不良组血清sST-2、GDF-15水平和NLR均明显高于预后良好组,差异均有统计学意义(P<0.05);预后良好组年龄、性别、病程、高血压、糖尿病、甘油三酯、胆固醇、高密度脂蛋白和低密度脂蛋白水平与预后不良组比较,差异均无统计学意义(P>0.05)。多因素Logistic回归分析发现,LVEF水平降低,血清sST-2、GDF-15水平和NLR升高为COPD合并PH发生预后不良的独立危险因素(P<0.05)。血清sST-2、GDF-15水平和NLR在诊断3项指标联合检测的灵敏度为78.6%,特异度为93.5%,受试者工作特征曲线下面积(AUC)为0.916,明显高于单项指标sST-2(Z=2.486,P=0.013)、GDF-15(Z=2.542,P=0.011)和NLR(Z=2.902,P=0.004)。结论血清sST-2、GDF-15水平和NLR是反映COPD合并PH严重程度的指标,3项指标联合检测有助于提高对COPD合并PH发生预后不良的诊断效能。

Objective To observe the diagnostic efficacy of serum soluble tumorigenicity factor-2(sST-2),growth differentiation factor-15(GDF-15)and neutrophil/lymphocyte ratio(NLR)in the poor prognosis of chronic obstructive pulmonary disease(COPD)associated pulmonary hypertension(PH).Methods A total of 121 patients diagnosed with COPD combined with PH in Shanghai Gongli Hospital of Pudong New Area from January 2020 to December 2021 were selected as COPD with PH group,according to the prognosis of COPD patients with PH,they were divided into good prognosis group(93 cases)and poor prognosis group(28 cases).Another selection during the same period 75 cases of simple COPD patients as COPD group,45 cases of healthy physical examination as healthy control group.According to the prognosis,the patients were divided into good prognosis group and poor prognosis group.The serum sST-2,GDF-15 levels and NLR in each group were compared,the multivariate analysis of the prognosis of COPD complicated with PH,the relationship between serum sST-2,GDF-15 levels and NLR and the severity of COPD complicated with PH,and the diagnostic value of poor prognosis of COPD complicated with PH.Results The serum sST-2,GDF-15 levels and NLR in COPD with PH group were significantly higher than those in COPD group and healthy control group,and those in COPD group were significantly higher than those in healthy control group,and the differences were statistically significant(P<0.05).The level of left ventricular ejection fraction(LVEF)in good prognosis group was significantly higher than that in poor prognosis group,and the levels of serum sST-2,GDF-15 levels and NLR in poor prognosis group were significantly higher than those in good prognosis group,and the differences were statistically significant(P<0.05).There was no significant difference in age,gender,course of disease,hypertension,diabetes,triglyceride,cholesterol,high-density lipoprotein and low-density lipoprotein levels between good prognosis group and poor prognosis group(P>0.05).Multivariate Lofistic regression analysis showed that decreased LVEF and increased serum sST-2,GDF-15 levels and NLR were independent risk factors for poor prognosis in COPD with PH(P<0.05).The sensitivity of serum sST-2,GDF-15 levels and NLR combined detection of the 3 indicators was 78.6%,the specificity was 93.5%,and the area under the receiver operating characteristic curve was 0.916,which was significantly higher than that of sST-2(Z=2.486,P=0.013),GDF-15(Z=2.542,P=0.011)and NLR(Z=2.902,P=0.004).Conclusion The serum sST-2,GDF-15 levels and NLR are indicators to reflect the severity of COPD combined with PH,and the combined detection of the 3 indicators can improve the diagnostic efficacy for the poor prognosis of COPD complicated with PH.