CTGF和IL-32对先天性心脏病相关肺动脉高压的联合诊断价值  

Combined diagnostic value of CTGF and IL-32 in pulmonary hypertension associated with congenital heart disease

作　　者：张伟[1,2] 刘文世[3] 吕文静 花颖 郑冬冬[1] 黄荣[1] 李晓飞[1] ZHANG Wei;LIU Wenshi;LYU Wenjing;HUA Ying;ZHENG Dongdong;HUANG Rong;LI Xiaofei(Department of Cardiology,the Affiliated Hospital of Nantong University,Nantong 226001;Medical School of Nantong University;Department of Cardiology,the Fifth Hospital of Xiamen,Fujian Province)

机构地区：[1]南通大学附属医院心血管内科,南通226001 [2]南通大学医学院 [3]福建省厦门市第五医院心血管内科

出　　处：《南通大学学报（医学版）》2022年第5期423-427,共5页Journal of Nantong University(Medical sciences)

基　　金：南通市科技计划项目(JCZ19106)。

摘　　要：目的:探讨结缔组织生长因子(connective tissue growth factor, CTGF)和白细胞介素-32(interleukin-32, IL-32)对先天性心脏病(congenital heart disease, CHD)相关肺动脉高压(pulmonary arterial hypertension, PAH)的诊断价值。方法:观察组纳入52例成年CHD患者,根据右心导管术测定的平均肺动脉压(mean pulmonary arterial pressure, PAPm)将患者分为:CHD-PAH组(PAPm≥25 mmHg)和CHD组(PAPm<25 mmHg)。对照组纳入25名健康成人体检者。采用酶联免疫吸附试验分别测定各组血清中IL-32和血浆中CTGF的水平,并分析CTGF、IL-32的诊断价值。结果:CHD-PAH组的血清IL-32、血浆CTGF水平均明显高于CHD组及对照组(均P<0.05);CHD患者血清IL-32水平与PAPm、肺动脉收缩压呈显著正相关(r=0.376、0.131,均P<0.05),血浆CTGF水平与PAPm、肺动脉收缩压、肺血管阻力呈显著正相关(r=0.662、0.620、0.652,均P<0.05),IL-32水平与CTGF呈正相关(r=0.409, P<0.05);通过受试者工作特征曲线分析IL-32、CTGF的最佳截断值分别为81.07、10.12 pg/mL,两项指标联合检测的灵敏度、特异度、准确率及约登指数分别为95.8%、71.4%、89.0%及0.672,除特异度外均明显高于两项指标单独检测。单因素及多因素回归分析发现CTGF及IL-32是CHD-PAH的独立危险因素(OR=2.478、1.052, P<0.05)。结论:IL-32、CTGF均是诊断CHD合并PAH的敏感指标及独立危险因素,且两项指标联合检测的诊断价值最大。Objective: To explore the value of connective tissue growth factor(CTGF) and interleukin-32(IL-32) in the diagnosis of pulmonary arterial hypertension(PAH) associated with congenital heart disease(CHD). Methods: In the observation group, 52adult patients with CHD were divided into two groups according to mean pulmonary arterial pressure(PAPm) determined by right heart catheterization: CHD-PAH group(PAPm≥25 mmHg) and CHD group(PAPm<25 mmHg). The control group was 25 healthy adults who underwent physical examination. The level of serum IL-32 and plasma CTGF were determined by enzyme-linked immunosorbent assay, and the diagnostic value of CTGF and IL-32 was analyzed. Results: Serum IL-32 and plasma CTGF levels were significantly higher in the CHD-PAH group than in the CHD and control groups(P<0.05). Serum IL-32 level was positively correlated with PAPm(r=0.376, P<0.05) and pulmonary artery systolic pressure(r=0.131, P<0.05). Plasma CTGF level was positively correlated with PAPm(r=0.662, P<0.05), pulmonary artery systolic pressure(r=0.620, P<0.05) and pulmonary vascular resistance(r=0.652, P<0.05), IL-32 level was positively correlated with CTGF(r=0.409, P<0.05). The best cut-off values of IL-32 and CTGF analyzed by receiver operating characteristic curve were 81.07 pg/mL, 10.12 pg/mL respectively. The sensitivity, specificity, accuracy and Youden index of the two combined indexes were 95.8%, 71.4%, 89.0% and 0.672respectively. All except specificity were significantly higher than the two measures tested alone. Univariate and multivariate regression analysis showed that CTGF, IL-32 was an independent risk factor for CHD-PAH( OR=2.478, 1.052, P<0.05).Conclusion: IL-32 and CTGF are sensitive indicators and independent risk factors for CHD and PAH, and the combined detection of the two indicators has the greatest diagnostic value.

关 键 词：先天性心脏病 肺动脉高压 白细胞介素-32 结缔组织生长因子 

分 类 号：R541.1[医药卫生—心血管疾病]