血清sST2联合混合静脉血氧饱和度在肺动脉高压患者死亡风险评估中的价值  

The value of serum sST2 combined with mixed venous oxygen saturation in the risk assessment of death in patients with pulmonary arterial hypertension

作　　者：蒋忠 黄叶 陆建保 赵新宇 周玉涛 JIANG Zhong;HUANG Ye;LU Jianbao;ZHAO Xinyu;ZHOU Yutao(Department of Respiratory Medicine,Liyang Branch,Jiangsu Provincial People′s Hospital/People′s Hospital of Liyang City,Liyang,Jiangsu 213300,China)

机构地区：[1]江苏省人民医院溧阳分院/溧阳市人民医院呼吸内科,江苏溧阳213300

出　　处：《国际检验医学杂志》2022年第13期1572-1576,1582,共6页International Journal of Laboratory Medicine

基　　金：江苏省卫生和计划生育委员会医学科研课题青年课题(Q201709)。

摘　　要：目的探讨血清可溶性致瘤因子-2(sST2)联合混合静脉血氧饱和度(SvO_(2))在肺动脉高压(PH)患者死亡风险评估中的价值。方法选取2018年1月至2021年1月于该院确诊为PH并进行治疗的患者共106例纳入研究,出院后随访12个月,期间32例死亡,74例存活。比较存活组与死亡组患者入院时的人口学资料、世界卫生组织功能分级(WHO-FC)、6分钟步行距离(6MWD)、疾病分型、血流动力学指标、超声指标、实验室指标和临床治疗方案。采用多因素Cox回归分析筛选得到死亡预测因子。结果单因素比较发现,死亡组年龄、WHO-FCⅢ~Ⅳ级所占比例、平均右房压(mRAP)、平均肺动脉压(mPAP)、肺血管阻力(PVR)、血尿素氮(BUN)和sST2均高于存活组,而6MWD、心输出量(CO)、SvO_(2)、肺动脉氧饱和度(PaO_(2))、经环平面收缩偏移均低于存活组,差异均有统计学意义(P<0.05)。Cox回归分析显示,SvO_(2)降低、BUN和sST2升高是PH患者死亡的独立预测因子(P<0.05)。受试者工作特征(ROC)曲线显示,sST2联合SvO_(2)预测死亡的曲线下面积(AUC)明显大于sST2、SvO_(2)、BUN单独使用及sST2、BUN联合使用(P<0.05)。根据sST2和SvO_(2)临界值将PH患者分为低风险组、中风险组和高风险组,生存曲线显示,高风险组患者累积生存率较低风险组和中风险组患者明显降低(P<0.05)。结论PH患者早期检测sST2和SvO_(2)对死亡风险评估具有重要意义,sST2升高和SvO_(2)降低提示死亡风险增加,sST2联合SvO_(2)预测死亡的效能最佳。Objective To investigate the value of serum soluble tumorigenicity-2(sST2)combined with mixed venous oxygen saturation(SvO_(2))for the risk assessment of death in patients with pulmonary hypertension(PH).Methods A total of 106 patients who were diagnosed with PH and treated in the hospital from January 2018 to January 2021 were enrolled in the study.They were followed up for 12 months after discharge.During this period,32 died and 74 survived.The demographic data,World Health Organization functional class(WHO-FC),6-minute walking distance(6MWD),disease type,hemodynamic indexes,ultrasound indexes,laboratory indexes and clinical treatment plan.Multivariate Cox regression analysis was used to screen for predictors of death.Results Univariate comparison showed that age,the proportion of WHO-FCⅢ-Ⅳ,mean right atrial pressure(mRAP),mean pulmonary arterial pressure(mPAP),pulmonary vascular resistance(PVR),blood urea nitrogen(BUN)and sST2 in the death group were higher than those in the survival group,while 6MWD,cardiac output(CO),SvO_(2),pulmonary arterial oxygen saturation(PaO_(2)),and trans-annular plane systolic excursion were all lower than those in the survival group,and the differences were statistically significant(P<0.05).Cox regression analysis showed that decreased SvO_(2),increased BUN and sST2 were independent predictors of death in PH patients(P<0.05).The receiver operating characteristic(ROC)curve showed that the area under the curve(AUC)of sST2 combined with SvO_(2) for predicting death was significantly greater than that of sST2,SvO_(2),BUN alone and sST2 combined with BUN(P<0.05).According to the sST2 and SvO_(2) cut-off values,PH patients were divided into low-risk group,medium-risk group and high-risk group.The survival curve showed that the cumulative survival rate of patients in the high-risk group was significantly lower in the lower-risk group and the middle-risk group(P<0.05).Conclusion Early detection of sST2 and SvO_(2) in PH patients is of great significance for the assessment of death risk

关 键 词：肺动脉高压 可溶性致瘤因子-2 混合静脉血氧饱和度 预后 

分 类 号：R446.11[医药卫生—诊断学]