慢性肺源性心脏病患者血清白细胞介素-6、降钙素原、D-二聚体、N端B型脑钠肽前体与心功能分级和预后的关系研究

摘要 目的：探讨慢性肺源性心脏病（CCP）患者血清白细胞介素-6（IL-6）、降钙素原（PCT）、D-二聚体（D-D）、N端B型脑钠肽前体（NT-proBNP）与心功能分级和预后的关系。方法：选取2020年1月～2021年5月合肥市第一人民医院全科医学科及呼吸与危重症科收治的170例CCP患者（CCP组），其中纽约心脏协会（NYHA）心功能分级Ⅱ级49例、Ⅲ级66例、Ⅳ级55例，根据1年后存活状况分为死亡组26例和存活组144例，另选取同期54名体检健康者（对照组）。收集CCP患者临床资料，采用酶联免疫吸附法检测血清IL-6、PCT、D-D、NT-proBNP水平。通过多因素Logistic回归分析CCP患者预后不良的影响因素，受试者工作特征（ROC）曲线分析血清IL-6、PCT、D-D、NT-proBNP水平对CCP患者预后不良的预测价值。结果：与对照组比较，CCP组血清IL-6、PCT、D-D、NT-proBNP水平升高（P＜0.05）。Ⅱ级、Ⅲ级、Ⅳ级CCP患者血清IL-6、PCT、D-D、NT-proBNP水平依次升高（P＜0.05）。单因素分析显示，死亡组NYHA心功能分级Ⅳ级、肺动脉收缩压、Tie指数和血清IL-6、PCT、D-D、NT-proBNP水平高于存活组，第1秒用力呼气容积（FEV₁）占预计值％、FEV₁/用力肺活量（FVC）、三尖瓣环收缩期位移低于存活组（P＜0.05）。多因素Logistic回归分析显示，NYHA心功能分级Ⅳ级和肺动脉收缩压、IL-6、PCT、D-D、NT-proBNP升高为CCP患者预后不良的独立危险因素，FEV1占预计值％升高为独立保护因素（P＜0.05）。ROC曲线分析显示，血清IL-6、PCT、D-D、NT-proBNP水平单独与联合预测CCP患者预后不良的曲线下面积分别为0.789、0.789、0.792、0.801、0.954，灵敏度分别为93.33％、66.67％、66.67％、86.67％、86.67％，特异度分别为46.67％、82.67％、85.33％、66.67％、94.67％。血清IL-6、PCT、D-D、NT-proBNP水平联合预测CCP患者预后不良的AUC大于单项预测（P＜0.05）。结论：CCP患者血清IL-6、PCT、D-D、NT-proBNP水平升高可增加心功能严重程度并导致预后不良，可作为CCP患者预后不良的辅助预测指标，且四项指标联合检测具有更好的预测效能。

Association Study of Serum Interleukin-6, Procalcitonin, D-Dimer and N-Terminal Pro-B-Type Brain Natriuretic Peptide and Cardiac Function Classification and Prognosis in Patients with Chronic Cor Pulmonale

ABSTRACT Objective: To investigate the relationship between serum interleukin-6 (IL-6), procalcitonin (PCT), D-dimer (D-D) and N-terminal pro-B-type brain natriuretic peptide (NT-proBNP) and cardiac function classification and prognosis in patients with chronic cor pulmonale (CCP). Methods: 170 patients with CCP who were admitted to the Department of General Medicine and the Department of Respiratory and Critical Care of the First People''s Hospital of Hefei from January 2020 to May 2021 (CCP group) were selected, including 49 cases of New York Heart Association (NYHA) cardiac function class II, 66 cases of class III and 55 cases of class IV. They were divided into 26 cases in the death group and 144 cases in the survival group according to their survival status after 1 year, and 54 healthy people with physical examination were also selected during the same period (control group). Clinical data of patients with CCP were collected, and serum IL-6, PCT, D-D and NT-proBNP levels were measured by enzyme-linked immunosorbent assay. Multi-factor Logistic regression was used to analyze the influencing factors of poor prognosis in patients with CCP, and receiver operating characteristic (ROC) curves were used to analyze the predictive value of serum IL-6, PCT, D-D and NT-proBNP levels on poor prognosis in patients with CCP. Results: Compared to the control group, the serum IL-6, PCT, D-D and NT-proBNP levels were increased in the CCP group (P<0.05). Serum IL-6, PCT, D-D and NT-proBNP levels were elevated sequentially in patients with grade II, grade III and grade IV CCP (P<0.05). Univariate analysis showed that NYHA cardiac function grade IV, pulmonary systolic pressure, Tie index and serum IL-6, PCT, D-D, NT-proBNP levels in the death group were higher than those in the survival group, while forced expiratory volume in one second (FEV₁) accounted for% of the expected value, FEV₁/forced vital capacity (FVC) and tricuspid annulus systolic displacement were lower than those in the survival group (P<0.05). Multi-factor Logistic regression analysis showed that NYHA cardiac function class IV and elevated pulmonary artery systolic blood pressure, IL-6, PCT, D-D and NT-proBNP were independent risk factors for poor prognosis in patients with CCP, and elevated FEV1 accounted for% of the expected value was an independent protective factor (P<0.05). ROC curve analysis showed that the area under the curve for serum IL-6, PCT, D-D and NT-proBNP levels alone and in combination to predict poor prognosis in patients with CCP was 0.789, 0.789, 0.792, 0.801 and 0.954, respectively, with sensitivities of 93.33%, 66.67%, 66.67%, 86.67%, and 86.67%, and the specificities were 46.67%, 82.67%, 85.33%, 66.67% and 94.67%, respectively. The AUC of serum IL-6, PCT, D-D and NT-proBNP levels combined to predict poor prognosis in patients with CCP was greater than that of the individual predictions (P<0.05). Conclusion: Elevated serum IL-6, PCT, D-D and NT-proBNP levels in patients with CCP can increase the severity of cardiac function and lead to poor prognosis, and can be used as an auxiliary predictor of poor prognosis in patients with CCP, and the combined detection of the four indicators has better predictive efficiency.