[1]唐文慧a,应会领a,段 静a,等.肺源性心脏病并发肺动脉高压患者血清β-NGF 和TRAIL 水平检测在临床诊断及预后评估中的意义[J].现代检验医学杂志,2024,39(04):131-137.[doi:10.3969/j.issn.1671-7414.2024.04.024]
　TANG Wenhuia,YING Huilinga,DUAN Jinga,et al.Significance of Serum β-NGF and TRAIL Testing in Clinical Diagnosis and Prognosis Assessment in Patients with Pulmonary Heart Disease Complicated with Pulmonary Artery Hypertension[J].Journal of Modern Laboratory Medicine,2024,39(04):131-137.[doi:10.3969/j.issn.1671-7414.2024.04.024]
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肺源性心脏病并发肺动脉高压患者血清β-NGF 和TRAIL 水平检测在临床诊断及预后评估中的意义()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第39卷
期数:
2024年04期
页码:
131-137
栏目:
论著
出版日期:
2024-07-15

文章信息/Info

Title:
Significance of Serum β-NGF and TRAIL Testing in Clinical Diagnosis and Prognosis Assessment in Patients with Pulmonary Heart Disease Complicated with Pulmonary Artery Hypertension
文章编号:
1671-7414（2024）04-131-07
作者:
唐文慧a; 应会领a; 段 静a; 董 卓b; 尤欣怡a
（北京市大兴区人民医院 a. 感染内科；b. 胸外科，北京 102600）
Author(s):
TANG Wenhuia; YING Huilinga; DUAN Jinga; DONG Zhuob; YOU Xinyia
(a. Department of Infectious Medicine；b. Department of Thoracic Surgery，Daxing District People’s Hospital of Beijing，Beijing 102600，China)
关键词:
β- 神经生长因子; 肿瘤坏死因子相关凋亡诱导配体; 肺源性心脏病; 肺动脉高压
分类号:
R541.5；R544.16；R392.11
DOI:
10.3969/j.issn.1671-7414.2024.04.024
文献标志码:
A
摘要:
目的 探讨肺源性心脏病（pulmonary heart disease，PHD）并发肺动脉高压（pulmonary heart disease，PAH）患者血清β- 神经生长因子（β-nerve growth factor，β-NGF）、肿瘤坏死因子相关凋亡诱导配体（tumor necrosisfactor-related apoptosis-inducing ligand，TRAIL）表达水平及其在临床诊断及预后评估中的意义。方法 采用1∶1 病例-对照研究设计选取2019 年1 月～ 2022 年6 月北京市大兴区人民医院86 例并发PAH 的PHD 患者为病例组，86 例单纯PHD 患者为对照组，进行回顾性分析。将病例组根据肺动脉收缩压（pulmonary arterial systolic pressure，PASP）分为轻度PAH 组（n=39）、中度PAH 组（n=25）和重度PAH 组（n=22），根据出院后一年的结果分为预后良好组（n=75）和预后不良组（n=11）。收集研究对象人口学资料和实验室检查指标，采用酶联免疫吸附（ELISA）法检测血清β-NGF，TRAIL 水平。Pearson 积矩相关分析β-NGF，TRAIL 与PASP 的关系，Logistic 回归分析PHD 患者PAH 影响因素，ROC 曲线评估β-NGF，TRAIL 对PAH 的诊断价值，COX 比例风险回归分析β-NGF，TRAIL 与PHD 并发PAH 患者预后不良的关系，ROC 曲线评估其对预后不良的预测价值。结果 与对照组比较，病例组PHD 病程长（8.63±1.27 年vs 5.49±1.15 年），血清β-NGF（26.97±8.25 ng/ml vs 22.14±7.32 ng/ml）和TRAIL（2.83±0.76 ng/ml vs 1.71±0.68ng/ml）水平升高，差异具有统计学意义（t=17.006，4.064，10.183，均P<0.05）。血清β-NGF，TRAIL 对PHD 患者PAH 有诊断价值，AUC 分别为0.842，0.838，二者联合诊断的AUC 为0.920，诊断价值高于单一指标（Z=3.416，3.508， 均P<0.05）。轻度PAH 组、中度PAH 组和重度PAH 组血清β-NGF（23.26±5.13 ng/ml，27.83±5.57 ng/ml，32.57±6.02 ng/ml），TRAIL（2.24±0.65 ng/ml，2.89±0.71 ng/ml，3.81±0.90 ng/ml）水平依次升高，差异具有统计学意义（F=20.624，31.972，均P<0.05）。病例组血清β-NGF，TRAIL 与PASP 呈正相关（r=0.673，0.659，均P<0.05）。预后不良组血清β-NGF（36.34±8.05 ng/ml），TRAIL（3.49±1.01 ng/ml）水平高于预后良好组（25.59±7.28ng/ml，2.73±0.89 ng/ml），差异具有统计学意义（t=4.516，2.604，均P<0.05）。Logistic 回归分析结果显示，PHD 病程[OR（95%CI）：1.784（1.135~2.806）]、β-NGF[OR （95%CI）：1.976（1.108~3.523）]，TRAIL[OR (95%CI)：1.866（1.123~3.101）] 是PHD 患者发生PAH 的独立危险因素（均P<0.05）。多因素COX 比例风险回归结果显示，PHD 病程[OR（95%CI）：1.167（1.082~1.364]、β-NGF[OR（95%CI）：1.322（1.134~1.649）]，TRAIL[OR（95%CI）：1.259（1.087~1.590）]是PHD 并发PAH 患者预后不良的独立危险因素（均P<0.05）。血清β-NGF，TRAIL 可预测PHD 并发PAH 患者预后不良发生风险，AUC 分别为0.863，0.881，二者联合检测的AUC 为0.907，诊断价值高于单一指标检测（Z=2.905，3.128，均P<0.05）。结论 血清β-NGF 和TRAIL 升高是PHD 患者PAH 独立危险因素，并与PAH 严重程度有关，早期联合β-NGF 和TRAIL 检测可提高对PAH 的诊断价值及对患者预后不良的预测效果。
Abstract:
Objective To explore the significance of serum β-nerve growth factor (β-NGF) and tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) testing in clinical diagnosis and prognosis assessment in patients with pulmonary heart disease (PHD) complicated with pulmonary artery hypertension (PAH). Methods A 1∶1 case-control study was conducted in Daxing District People’s Hospital of Beijing from January 2019 to June 2022, in which 86 patients with PHD complicated with PAH and 86 patients with isolated PHD were selected as case group and control group. Retrospective analysis was conducted. The case group was divided into mild PAH group (n=39), moderate PAH group (n=25) and severe PAH group (n=22) according to pulmonary artery systolic pressure (PASP). Meanwhile, the case group was divided into good prognosis group (n=75) and poor prognosis group (n=11) based on the outcomes after one year of discharge. Demographic data and laboratory examination indicators of study subjects were collected, and serum β-NGF and TRAIL levels were measured using enzyme-linked immunosorbent assay(ELISA). Pearson product-moment correlation analysis was used to assess the relationship among β-NGF, TRAIL and PASP. Logistic regression analysis was performed to identify factors influencing PAH in patients with PHD. ROC curve was used to evaluate the diagnostic value of β-NGF and TRAIL for PAH. Cox proportional hazards regression analysis was carried out to assess the relationship among β-NGF, TRAIL and poor prognosis in patients with PHD complicated with PAH, and ROC curve was used to evaluate its predictive value for poor prognosis. Result Compared with control group，the duration of PHD in case group was longer (8.63±1.27 years vs 5.49±1.15 years), and serum β-NGF level (26.97±8.25 ng/ml vs 22.14±7.32 ng/ml) and TRAIL level (2.83±0.76 ng/ml vs 1.71±0.68 ng/ml) were increased, with significant differences (t=17.006, 4.064, 10.183, all P<0.05). Serum β-NGF and TRAIL had certain diagnostic values for PAH in PHD patients, with AUC of 0.842 and 0.838, respectively. And the combined diagnostic AUC was 0.920, which was higher than that of single indicators (Z=3.416, 3.508, all P<0.05). Serum β-NGF (23.26±5.13 ng/ml, 27.83±5.57 ng/ml, 32.57±6.02 ng/ml) and TRAIL (2.24±0.65 ng/ml, 2.89±0.71 ng/ml, 3.81±0.90 ng/ml) levels among patients with mild PAH, moderate PAH, severe PAH were sequentially elevated, and the differences were significant (F=20.624，31.972，all P<0.05). Serum β-NGF and TRAIL were positively associated with PASP (r=0.673，0.659，P<0.05). Serum β-NGF (36.34±8.05 ng/ml) and TRAIL (3.49±1.01 ng/ ml) levels in poor prognosis group were higher compared to good prognosis group (25.59±7.28 ng/ml, 2.73±0.89 ng/ml), and the differences were significant (t=4.516, 2.604, all P<0.05). Logistic regression analysis showed that，the PHD duration [OR(95%CI):1.784(1.135~2.806)]，β-NGF[OR(95%CI):1.976(1.108~3.523)] and TRAIL [OR(95%CI):1.866(1.123~3.101)] were independent risk factors for occurrence of PAH in patients with PHD ( all P<0.05)．Multivariate COX proportional risk regression results showed that PHD duration [OR(95%CI):1.167(1.082~1.364)],β-NGF[OR(95%CI):1.322(1.134~1.649)], TRAIL[ OR(95%CI):1.259(1.087~1.590)] were independent risk factors for poor prognosis in patients with PHD complicated with PAH (all P<0.05). Serum β-NGF and TRAIL could predict the poor prognosis in patients with PHD complicated with PAH, with AUC of 0.863 and 0.881, respectively. The combined diagnostic AUC was 0.907, which was higher than that of single indicators (Z=2.905, 3.128, all P<0.05). Conclusion Elevated serum β-NGF and TRAIL were independent risk factors for PAH and were associated with severity of PAH. Early combined detection of β-NGF and TRAIL can improve the diagnostic value for PAH and predict poor prognosis of patients.

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备注/Memo

备注/Memo:
基金项目：首都卫生发展科研专项项目（首发2020-3-7122）。
作者简介：唐文慧（1981-），女，本科，主治医师，研究方向：呼吸与感染相关疾病，E-mail： tangwenhui564@126.com。
更新日期/Last Update: 2024-07-15