心脏Tei指数、血清ROCK1、Fibulin-5联合对先天性心脏病患者并发肺动脉高压的诊断价值OA
The diagnostic value of the combination of cardiac Tei index,serum ROCK1,and Fibulin-5 for complicated pulmo-nary arterial hypertension in patients with congenital heart disease
目的 探究心脏 Tei 指数、血清 Rho 相关卷曲螺旋蛋白激酶 1(ROCK1)、衰老关键蛋白抗原-5(Fibulin-5)联合对先天性心脏病(CHD)患者并发肺动脉高压(PAH)的诊断价值.方法 选取 2023 年 4 月—2025 年4 月首都医科大学附属北京安贞医院收治的 CHD-PAH 患者 90 例作为 CHD-PAH 组,单纯 CHD 患者 90 例作为 CHD组.采用多普勒超声检测心脏 Tei 指数,ELISA 法检测血清 ROCK1、Fibulin-5 水平;Spearman 法分析心脏 Tei 指数、ROCK1、Fibulin-5与 CHD-PAH 患者病情程度的相关性;多因素 Logistic 回归分析 CHD-PAH 发生的影响因素;采用ROC 曲线分析心脏 Tei 指数及血清 ROCK1、Fibulin-5水平对 CHD-PAH 的诊断价值;Bootstrap 法(1 000 次重复抽样)对 CHD-PAH 发生诊断模型进行内部验证.结果 CHD-PAH 组 NYHA 心功能分级Ⅲ～Ⅳ级占比、心脏 Tei 指数及血清 ROCK1、Fibulin-5水平均高于 CHD 组(χ2/P=28.357/＜0.001,t/P=7.488/＜0.001、7.925/＜0.001、7.634/＜0.001);心脏 Tei 指数、ROCK1、Fibulin-5均与 NYHA 心功能分级呈正相关(r/P=0.275/＜0.001、0.424/＜0.001、0.298/＜0.001).NYHA 心功能分级Ⅲ～Ⅳ级、心脏 Tei 指数高、ROCK1高、Fibulin-5高是 CHD-PAH 发生的独立危险因素[OR(95%CI)=2.950(1.382～6.299)、3.284(1.389～7.764)、3.975(1.518～10.406)、2.536(1.360～4.730)].心脏 Tei 指数、ROCK1、Fibulin-5单独及三者联合预测 CHD-PAH 发生的 ROC 曲线下面积(AUC)分别为 0.781、0.800、0.790、0.908,三者联合优于各自单独诊断的价值(Z/P=3.947/＜0.001、3.812/＜0.001、3.730/＜0.001).Hosmer-Lemeshow 检验提示CHD-PAH诊断模型拟合良好(χ2=6.064,df=8,P=0.640),证实预测概率与实测结果间具有良好的一致性.结论 CHD-PAH 患者心脏 Tei 指数及血清 ROCK1、Fibulin-5水平升高,三者联合诊断 CHD-PAH 的效能较高.
Objective To explore the diagnostic value of the combination of cardiac Tei index,serum Rho-associated coiled-coil kinase 1(ROCK1),and Fibulin-5 for complicated pulmonary arterial hypertension(PAH)in patients with congenital heart disease(CHD).Methods A total of 90 patients with CHD-PAH who were admitted to Beijing Anzhen Hospital,Capital Medical University from April 2023 to April 2025 were selected as the CHD-PAH group and 90 CHD pa-tients with simple CHD were selected as the CHD group.Serum levels of ROCK1 and Fibulin-5 were detected by ELISA.Logistic regression analysis was used to analyze the influencing factors of CHD-PAH.The diagnostic value of cardiac Tei in-dex,serum ROCK1,and Fibulin-5 for CHD-PAH was analyzed by ROC curve.Internal validation was conducted using the Bootstrap method(1000 repeated samplings).Results Compared with the CHD group,the proportion of NYHA class Ⅲ-Ⅳ,Tei index,and serum levels of ROCK1 and Fibulin-5 were significantly higher in the CHD-PAH group(χ2/t=28.357,7.488,7.925,7.634,all P<0.001).High NYHA class[OR(95%CI)=2.950(1.382-6.299)],high Tei index[OR(95%CI)=3.284(1.389-7.764)],high serum ROCK1 level[OR(95%CI)=3.975(1.518-10.406)],and high Fibulin-5 level[OR(95%CI)=2.536(1.360-4.730)]were independent risk factors for the occurrence ofCHD-PAH.T he AUCs of cardiac Tei index,serum ROCK1,Fibulin-5 alone,and their combination for diagnosing CHD-PAH were 0.781,0.800,0.790,and 0.908,respec-tively.The combined diagnosis was significantly superior to each individual index(DeLong method:Z combination-Tei index=3.947,Z combination-ROCK1=3.812,Z combination-Fibulin-5=3.730,all P<0.001).The cutoff values for cardiac Tei in-dex,serum ROCK1,and Fibulin-5 were 0.56,21.73 ng/mL,and 3.94 ng/mL,respectively.Moreover,the Hosmer-Lemeshow test indicated a good model fit(χ2=6.064,df=8,P=0.640),confirming good consistency between the predicted probability and the measured results.Conclusion Cardiac Tei index,serum ROCK1,and Fibulin-5 levels are elevated in patients with CHD-PAH.The combination of these three parameters has high diagnostic efficacy for CHD-PAH.
徐冠一;陈凌霄;陈丽;王霄芳
100029 北京,首都医科大学附属北京安贞医院小儿心脏中心100029 北京,首都医科大学附属北京安贞医院小儿心脏中心100029 北京,首都医科大学附属北京安贞医院小儿心脏中心100029 北京,首都医科大学附属北京安贞医院小儿心脏中心
医药卫生
先天性心脏病肺动脉高压心脏Tei指数血清Rho相关卷曲螺旋蛋白激酶1衰老关键蛋白抗原-5诊断
Congenital heart diseasePulmonary arterial hypertensionTei indexRho-associated coiled-coil kinase 1Fibulin-5Diagnosis
《疑难病杂志》 2026 (8)
918-922,5
2021年度"扬帆"计划临床技术创新项目(2021283)2021 "Yangfan" Plan Clinical Technology Innovation Project(2021283)
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