The Levels And Clinical Significance Of Serum Soluble CD137 In Patients With Pulmonary Hypertension Due To Left Heart Disease

ObjectiveThe aim of this study was to investigate the serum soluble CD137(sCD137)in patients with pulmonary hypertension related to left heart diseases(PH-LHD),and to explore the clinical significance of sCD137 in PH-LHD.Methods1.Research objects: A total of 76 LHD patients with left heart disease(LHD)diagnosed by clinical,echocardiography and coronary angiography were selected,PH was defined by pulmonary artery systolic pressure(PASP)≥40 mmHg and patients divided into 2 groups: 40 patients with LHD(LHD group)while 36 patients with PHLHD(LHD group),a healthy control group consists of 30 healthy adults who have been checked by the medical examination center.2.Research Method: Collect and record the clinical routine data,parameters of transthoracic echocardiography and related biochemical indexes of the three groups.The serum was separated from peripheral blood samples of the research objects.The levels of sCD137 in the serum was measured by an enzyme-linked immunosorbent assay(ELISA).3.Statistical Method: All data were calculated and analyzed by SPSS 23.0 statistical software.The mean ± standard deviation(? ±s)was used to represent the continuous variable data of normal distribution.The single factor analysis of variance was used to compare the mean among groups.If the continuous variable is not normally distributed,the data is expressed as the median(P25,P75).The Kruskal-Wallis H test was used to analyze the differences between multiple groups,the comparison between the two groups were analyzed by non-parametric Mann-Whitney U test;Chi-square test or Fisher exact test were used for categorical variables.The correlation between sCD137 and the different clinical parameters was calculated by Spearman correlation analysis.Logistic regression was used for single factor and multivariate analysis;The receiver operating characteristic(ROC)curve was used to analyze the predictive value of CD137 level and other related factors for PH-LHD.P<0.05 was considered statistically significant.Results1.Serum sCD137 levels in the control group,LHD group and PH-LHD group increased sequentially,and the differences are statistically significant(P<0.05).2.Correlation analysis showed that serum sCD137 levels were positively correlated with age,serum creatinine(Scr),brain natriuretic peptide(BNP),left atrial diameter(LAD),left ventricular end-diastolic diameter(LVDd),left ventricular endsystolic diameter(LVDs),and PASP(all P<0.05),with the highest correlation with LVDs(r = 0.556,P<0.001)and negatively with LVEF correlation(r=-0.444,P<0.001).3.Logistic regression analysis showed that levels of serum sCD137 levels,BNP,and triglyceride/ high density lipoprotein cholesterol(TG/HDL-C)were independent influencing factors of PH-LHD.4.The receiver operating characteristic(ROC)curve showed that the area under the curve(AUC)of PH-LHD predicted by sCD137 was 0.722(95%CI:0.607~0.837,P=0.001),the cut-off value was >8.22pg/mL,with the sensitivity at 0.611,specificity at 0.750.When combined with BNP and TG/HDL-C,the AUC of predicting PH-LHD was 0.910(95%CI:0.841~0.980,P<0.001),the cut-off value was >0.53,with the sensitivity at 0.778,specificity at 0.950.Conclusion1.The serum sCD137 levels in patients with PH-LHD was higher than that in LHD group and control group,and positively correlated with the severity of PH,suggesting that sCD137 may be a potential serum biomarker of PH-LHD and participate in its occurrence and development.2.Serum sCD137 levels was positively correlated with LAD,LVDd,LVDs,PASP,and negatively correlated with LVEF.It is speculated that sCD137 level may reflect ventricular remodeling and left ventricular function.3.Serum sCD137,TG/HDL-C and plasma BNP are independent influencing factors of PH-LHD.A certain value was showed in sCD137 of predicting the occurrence of PH-LHD in LHD patients which was better when combined with BNP and TG.