Clinical Value Of Asymmetrical Dimethyl-L-Arginine Detection In Patients With Connective Tissue Disease-Associated Pulmonary Arterial Hypertension

Objective:To investigate the clinical value of serum asymmetrical dimethyl-L-arginine(ADMA)in patients with connective tissue disease-associated pulmonary arterial hypertension(CTD-PAH).Methods:88 patients with CTD were recruited between December 2017 and August 2018 in Jiangxi Provincial People’s Hospital。Patients were further divided into 2 groups: CTD-without PAH(group A,n=45)and CTD-with PAH(group B,n=43)according to the pulmonary systolic blood pressure measured by echocardiography.40 healthy controls were also included(group c,n=40).The clinical data,including laboratory examinations,echocardiographic measurements,pulmonary function and ADMA levels determined by enzyme-linked immunosorbent assay(ELISA)were collected.The correlation between ADMA level and the occurrence of PAH,pulmonary function and other laboratory indexes in CTD patients were analyzed.Statistic analyses were performed by SPSS(version 23.0),p < 0.05 was considered statisticaly significant.Results:The serum level of ADMA in CTD-with PAH group was significantly higher than that of CTD-without PAH group and healthy control group,the ADMA level was(0.706±0.153)umol/L、(1.015±0.122)umol/L、(0.661±0.113)umol/L respectively(P<0.05).There was no significant difference between the CTD-without PAH group and healthy control group(P>0.05).Correlation analysis showed that serum ADMA level was positively correlated with sPAP and NT-proBNP,and negatively correlated with DLCO%(r = 0.802,0.475,-0.585,P < 0.001).Multivariate analysis indicated that elevated serum ADMA levels were a risk factor for CTD-PAH(OR=57.460,P<0.001).Using the receiver operating characteristic(ROC)curveanalysis,at the cut-off level of 0.810umol/L,ADMA showed good diagnositic efficacy:sensitivity 97.7%,specificity 75.6%,the area under the curve(AUC)was0.947(P<0.001).Conclusion:1、This study showed that serum ADMA levels in CTD-PAH patients were significantly higher than those in CTD patients and healthy controls,and multivariate analysis showed that ADMA was an independent risk factor for CTD-with PAH.It is suggested that the detection of serum ADMA may be a noninvasive method for the diagnosis of CTD-with PAH.2、In this study,correlation analysis showed that serum ADMA levels were positively correlated with sPAP and NT-proBNP levels,and negatively correlated with DLCO% levels,suggesting that serum ADMA levels were correlated with the severity of PAH in CTD patients,and ADMA might be an indicator of the development of CTD-with PAH patients.3、The detection method of serum ADMA level is noninvasive,inexpensive,easy to obtain and operate repeatedly;Moreover,the results are relatively stable in this way.So the serum ADMA may be an effective index for the follow-up and evaluation of the disease in CTD-with PAH patients.