| 肌肉生长抑制蛋白预测肺动脉高压风险的分析 |
| 投稿时间：2017-12-10 修订日期：2017-12-15 点此下载全文 |
| 引用本文：王毅,王洪敏,高艳锋,刘世伟,李伟.肌肉生长抑制蛋白预测肺动脉高压风险的分析[J].医学研究杂志,2018,47(11):183-188 |
| DOI：
10.11969/j.issn.1673-548X.2018.11.041 |
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| 中文摘要:目的 探讨肌肉生长抑制蛋白预测慢性阻塞性肺疾病（COPD）所致肺动脉高压风险性所发挥的作用，为临床进一步诊疗提供参考依据。方法 选取2013年9月~2015年9月在笔者医院首次就诊的COPD且无肺动脉高压的患者189例作为研究对象，记录其年龄、BMI、PH、PaO2、PaCO2、C反应蛋白、CV/TLC、FEV1/FVC、血BNP值、血SUA值、肌肉生长抑制蛋白、FEV1占预计值%、RVD、RAD、左心室射血分数、右心室变化分数等指标。所有患者的随访期为2年，单因素分析影响慢阻肺患者预后的因素；COX回归模型进一步分析差异具有统计学意义的指标对COPD患者预后影响的程度； ROC曲线分析血BNP值和肌肉生长抑制蛋白水平在预测COPD患者肺动脉高压风险性的敏感度和特异性。结果 单因素分析提示，患者CV/TLC、FEV1/FVC、血BNP值、血SUA值、肌肉生长抑制蛋白、FEV1占预计值%、右房横径、右心室变化分数均能影响患者预后情况，差异有统计学意义（P<0.05）。COX回归结果提示患者的患者的血BNP值（P=0.021）、肌肉生长抑制蛋白（P=0.017）是影响PH风险的独立影响因素，且肌肉生长抑制蛋白影响程度明显高于血BNP值（RR=2.893 vs RR=2.415）；ROC曲线下肌肉生长抑制蛋白值的AUC为0.797，（95%可信区间为0.708~0.886），其敏感度和特异性分别为76.8%、71.2%；血BNP值的AUC为0.752，（95%可信区间为0.657~0.847），敏感度和特异性分别为72.1%、66.3%； 结论 肌肉生长抑制蛋白水平在评估COPD患者肺动脉高压风险方面表现出较好的预测能力，有望作为COPD患者的常规评估指标，为临床指导治疗提供依据。 |
| 中文关键词:慢性阻塞性肺疾病 肺动脉高压 肌肉生长抑制蛋白 脑钠肽 血尿酸 临床价值 |
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| Clinical Value of Muscle Growth Inhibitory Protein in Evaluating Patients with Pulmonary Hypertension due to Chronic Obstructive Pulmonary Disease |
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| Abstract:Objective To investigate the role of myostatin in the prediction of the risk of pulmonary hypertension induced by chronic obstructive pulmonary disease (COPD) and provide a reference for clinical further diagnosis and treatment. Methods A total of 189 patients with chronic obstructive pulmonary disease and no pulmonary arterial hypertension who were diagnosed as "gold standard" from September 2013 to September 2015 in our hospital were selected as subjects and their age, BMI, PH, PaO2, PaCO2, C reactive protein, CV/TLC, FEV1/FVC, blood BNP, blood SUA, muscle growth inhibitory protein, FEV1 accounted for the predicted value%, RVD, RAD, left ventricular ejection fraction, right ventricular changes and other indicators. All patients were followed up for 2 years. Univariate analysis was used to analyze the prognostic factors in patients with COPD. Cox regression model was used to further analyze the influence of statistically significant indicators on the prognosis of patients with COPD. ROC curve analysis of blood BNP and muscle growth inhibition of protein levels in predicting risk of sensitivity and specificity in patients with COPD with pulmonary hypertension. Results Univariate analysis showed that the patients' prognosis was affected by CV/TLC, FEV1/FVC, BNP, SUA, FEV1% of right ventricle and right ventricle. There was statistical significance (P<0.05). The results of Cox regression suggested that BNP (P=0.021) and myostatin (P=0.017) were independent risk factors for PH in patients, and the effect of myostatin was significantly higher than that of blood BNP (RR=2.893 vs RR=2.415). The AUC of ROC curve was 0.797 (95% confidence interval 0.708-0.886). The sensitivity and specificity were 76.8% and 71.2% respectively. The AUC of blood BNP Was 0.752 (95% confidence interval was 0.657-0.847). The sensitivity and specificity were 72.1% and 66.3% respectively. Conclusion Muscle growth inhibitory protein level has a good predictive ability in assessing the risk of pulmonary hypertension in COPD patients. It is expected to serve as a routine evaluation index for COPD patients and provide the basis for clinical guidance. |
| keywords:Chronic obstructive pulmonary disease Pulmonary hypertension Myostatin Brain natriuretic peptide Serum uric acid Clinical value |
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