血清UⅡ和SCUBE1对阻塞性睡眠呼吸暂停低通气综合征患者心血管事件结局的预测价值

Value of Serum UⅡand SCUBE1 in Predicting Cardiovascular Event Outcomes in Obstructive Sleep Apnea-hypopnea Syndrome Patients

目的研究血清尾加压素Ⅱ(urotensinⅡ,UⅡ)和信号肽-CUB-表皮生长因子样结构域蛋白1(signal peptide,CUB domain and EGF like domain containing 1,SCUBE1)对阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea-hypopnea syndrome,OSAHS)患者主要不良心血管事件(major adverse cardiovascular events,MACE)发生的预测价值。方法选取2019-02/2022-02月作者医院诊治的106例OSAHS患者(OSAHS组)和同期体检的60例健康人(对照组)为研究对象。根据睡眠呼吸暂停低通气指数(apnea hypopnea index,AHI)和夜间最低氧饱和度(lowest oxygen saturation,LSaO_(2)),分为轻度组(n=42)、中度组(n=36)和重度组(n=28)。根据随访1年期间是否发生MACE,分为MACE组(n=32)和非MACE组(n=74)。采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测血清UⅡ、SCUBE1水平。采用Logistic回归分析和受试者工作特征(receiver operating characteristic,ROC)曲线分析血清UⅡ、SCUBE1水平对OSAHS患者MACE发生的预测价值。结果OSAHS组患者血清UⅡ、SCUBE1水平均明显高于对照组,组间比较差异具有统计学意义(P均<0.001)。轻度组、中度组及重度组OSAHS患者血清UⅡ、SCUBE1水平依次升高,组间比较差异均具有统计学意义(P均<0.05)。MACE组OSAHS患者OSAHS病程、AHI、血清UⅡ水平、SCUBE1水平均明显高于非MACE组,LSaO_(2)水平低于非MACE组,组间比较差异均具有统计学意义(P均<0.05)。AHI、血清UⅡ、血清SCUBE1是影响OSAHS患者MACE发生的独立危险因素,LSaO_(2)是保护因素。血清UⅡ、SCUBE1及二者联合对预测OSAHS患者MACE发生的曲线下面积(area under the curve,AUC)分别为0.846(95%CI:0.801~0.894),0.812(95%CI:0.770~0.839),0.904(95%Cl:0.860~0.943),二者联合检测的预测效能高于血清UⅡ、SCUBE1单独检测。结论OSAHS患者血清UⅡ、SCUBE1水平升高,二者与OSAHS病情程度有关,均参与OSAHS疾病进展过程。血清UⅡ、SCUBE1联合检测对OSAHS患者MACE发生具有较高的预测价值,是新的评估MACE预后的血清标志物。

Objective To investigate the value of serum urotensinⅡ(UⅡ)and signal peptide,CUB domain and EGF like domain containing 1(SCUBE1)in predicting the occurrence of major adverse cardiovascular events(MACE)in obstructive sleep apnea-hypopnea syndrome(OSAHS)patients.Methods A total of 106 OSAHS patients(OSAHS group)who were diag-nosed and treated in author's hospital from February 2019 to February 2022 and 60 healthy people(control group)who under-went physical examination during the same period were selected as the research objects.The patients were divided into mild group(n=42),moderate group(n=36)and severe group(n=28)according to apnea hypopnea index(AHI)and lowest oxygen saturation(LSaO_(2))at night.According to whether MACE occured within 1 year follow up,the patients were divided into MACE group(n=32)and non-MACE group(n=74).The levels of serum UⅡand SCUBE1 were detected by enzyme linked immunosorbent assay(ELISA).The predictive value of serum UⅡand SCUBE1 levels for MACE in OSAHS patients were analyzed by Logistic regression analysis and receiver operating characteristic(ROC)curve.Results The levels of serum UⅡand SCUBE1 in OSAHS group were significantly higher than those in control group,and the difference between the two groups was statistically signifi-cant(all P<0.001).The levels of serum UⅡand SCUBE1 of OSAHS patientes in the mild,moderate and severe groups increased successively,and the difference between the two groups was statistically significant(all P<0.05).The disease course of OSAHS,AHI,serum UⅡlevel and SCUBE1 level of OSAHS patients in MACE group were significantly higher than those in the non-MACE group,and LSaO_(2)level was lower than that in the non-MACE group,and the difference between the two groups was statistically significant(all P<0.05).AHI,serum UⅡand ser-um SCUBE1 were identified as independent risk factors for the occurrence of MACE in OSAHS patients,while LSaO_(2)was found to be the protective factor.The area under the curve(AUC)of serum UⅡ,SCUBE1 and combination of the two for predicting the occurrence of MACE in OSAHS patients was 0.846(95%CI:0.801-0.894),0.812(95%CI:0.770-0.839)and 0.904(95%CI:0.860-0.943)respectively.The predictive efficacy of combined detection of the two was higher than that of serum UⅡand SCUBE1 alone.Conclusion The levels of serum UⅡand SCUBE1 are increased in OSAHS patients,which are related to the severity of OSAHS,and they are both involved in the progression of OSAHS.The combined detection of serum UⅡand SCUBE1 has a high predictive value for the occurrence of MACE in OSAHS patients,and it is a new serum mark-er for evaluating the prognosis of MACE.