血清趋化因子CCL21水平对妊娠期高血压患者心血管不良事件的预测价值

Predictive value of serum chemokine CCL21 level for adverse cardiovascular events in patients with gestational hypertension

目的探讨血清趋化因子CCL21水平对妊娠期高血压患者心血管不良事件的预测价值。方法选取2018年3月至2020年1月北京丰台医院收治的45例妊娠期高血压患者(病例组)和45例同期血压正常妊娠女性(对照组)纳入研究,入院后第2天清晨进行采血,采用酶联免疫吸附实验(ELISA)测定其血清CCL21水平,出院后均随访3年,比较两组产妇的心血管危险因素[体质量指数(BMI)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、收缩压(SBP)、舒张压(DBP)]及心血管不良事件发生率;同时比较有心血管不良事件和无心血管不良事件产妇的血清CCL21水平,且通过受试者工作特征曲线(ROC)分析血清CCL21水平对妊娠期高血压患者心血管不良事件的预测价值。结果病例组产妇的血清CCL21水平为(160.34±21.57)ng/L,明显高于对照组的(125.48±16.53)ng/L,差异有统计学意义(P<0.05);产后3年,病例组产妇的FPG、TG、SBP、DBP水平分别为(5.60±0.75)mmol/L、(1.08±0.46)mmol/L、(123.89±12.93)mmHg、(86.80±9.34)mmHg,明显高于对照组的(5.07±0.64)mmol/L、(0.76±0.34)mmol/L、(111.58±10.76)mmHg、(78.81±8.42)mmHg,差异均具有统计学意义(P<0.05),但产后3年,两组产妇的BMI、TC、HDL-C、LDL-C水平比较差异均无统计学意义(P>0.05);病例组产妇产后3年的心血管不良事件发生率为13.33%,而对照组产后3年无心血管不良事件发生,差异具有统计学意义(P<0.05);有心血管不良事件患者的血清CCL21水平为(173.14±16.86)ng/L,明显高于无心血管不良事件者的(155.76±15.92)ng/L,差异有统计学意义(P<0.05);经ROC分析结果显示,血清CCL21对妊娠期高血压患者产后3年发生心血管不良事件的曲线下面积(AUC)为0.80,血清CCL21临界值为160.24 ng/L时,诊断灵敏度为0.620,特异度为0.950。结论血清CCL21水平对妊娠期高血压患者心血管不良事件有一定的预测价值。

Objective To investigate the predictive value of serum chemokine CCL21 level for adverse cardiovascular events in patients with gestational hypertension.Methods The CCL21 levels in 45 patients with gestational hypertension(case group)and 45 pregnant women with normal blood pressure(control group)who were admitted to Beijing Fengtai Hospital during the period from March 2018 to January 2020 were determined by enzyme linked immunosorbent assay(ELISA)in the morning on the second day after admission.All subjects were followed up for 3 years after discharge.Cardiovascular risk factors[body mass index(BMI),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),fasting plasma glucose(FPG),systolic blood pressure(SBP),diastolic blood pressure(DBP)],and incidence of adverse cardiovascular events were compared between the two groups.Serum CCL21 levels was compared between mothers with and without adverse cardiovascular events.The predictive value of serum chemokine CCL21 level for adverse cardiovascular events in patients with gestational hypertension was analyzed through receiver operating characteristic(ROC)curve.Results In the case group,serum CCL21 was(160.34±21.57)ng/L,and 3-year postpartum FPG,TG,SBP,and DBP levels were(5.60±0.75)mmol/L,(1.08±0.46)mmol/L,(123.89±12.93)mmHg,and(86.80±9.34)mmHg,respectively,which were significantly higher than(125.48±16.53)ng/L,(5.07±0.64)mmol/L,(0.76±0.34)mmol/L,(111.58±10.76)mmHg,and(78.81±8.42)mmHg in the control group(P<0.05).There was no statistically significant difference in BMI,TC,HDL-C,and LDL-C levels between the two groups at 3 years postpartum(P>0.05).The incidence of adverse cardiovascular events in the case group was 13.33%in the 3-year postpartum period,and there were no adverse cardiovascular events in the control group in the 3-year postpartum period,with no statistically significant difference between the two groups(P<0.05).The serum CCL21 level of patients with adverse cardiovascular events was(173.14±16.86)ng/L,which was significantly higher than(155.76±15.92)ng/L in those without cardiovascular adverse events(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum CCL21 for adverse cardiovascular events in patients with gestational hypertension in 3-year postpartum period was 0.80.When the critical value was 160.24 ng/L,the diagnostic sensitivity and specificity of CCL21 were 0.620 and 0.950.Conclusion Serum CCL21 level is of certain predictive value for adverse cardiovascular events in patients with gestational hypertension.