人类免疫缺陷病毒相关肺动脉高压患者的肺动脉管径特征及联合肿瘤坏死因子-α的诊断价值

doi:10.3969/j.issn.1006-5725.2024.13.018

Abstract

Abstract:

Objective To investigate the characteristics of pulmonary artery diameter in patients with human immunodeficiency virus （HIV） infection-associated pulmonary hypertension （PAH）， and to explore the clinical significance of pulmonary artery diameter correlation indices combined with tumor necrosis factor-α （TNF-α） for early screening and diagnosis of HIV-associated pulmonary hypertension， aiming to provide valuable clinical insights. Methods A retrospective analysis was conducted on 65 HIV-infected patients admitted to the Eighth Hospital Affiliated to Guangzhou Medical University between May 2017 and December 2023. Based on echocardiography findings， the patients were categorized into an observation group （23 cases with PAH） and a control group （42 cases without PAH）. Measurements of pulmonary artery diameter （PA）， distal pulmonary artery diameter （dPA）， and aortic diameter were obtained in both groups， and the ratio of dPA to aortic diameter （rPA） was calculated. Additionally， serum TNF-α levels were recorded. The clinical significance of each index in early screening and diagnosis of HIV-related pulmonary hypertension was analyzed. Results The PA， dPA， rPA， and TNF-α levels in the observation group were significantly higher compared to those in the control group. Pearson linear correlation analysis revealed a significant positive correlation between TNF-α and both dPA and rPA. Two-column correlation analysis demonstrated a significant association between HIV-PAH and PA， dPA， rPA， as well as TNF-α （P < 0.05）. The combined measurement of serum TNF-α with dPA and rPA exhibited an area under the curve （AUC） of 0.891 for diagnosing HIV-APAH， with a sensitivity of 0.870 and specificity of 0.881. Conclusion The combination of pulmonary artery diameter and TNF-α provides a more accurate indication of the presence of HIV-PAH， enabling early screening， follow-up， or intervention in high-risk patients. This finding holds significant implications for enhancing patient prognosis.

Key words: humanimmunodeficiency virus, pulmonary hypertension, artery diameter, tumor necrosis factor-α

CLC Number:

Qingyuan XU,Weifeng YUAN,Mu CHEN,Xiaoneng. MO. Research on the diagnostic value of pulmonary artery diameter characteristics and combined TNF-α in patients with HIV associated pulmonary hypertension[J]. The Journal of Practical Medicine, 2024, 40(13): 1869-1874.

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References 22

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指标	组别	测量值	t值	P值
PA（mm）	观察组对照组	23.09 ± 3.32 20.05 ± 2.02	-4.007	< 0.001
dPA（cm）	观察组对照组	3.05 ± 0.48 2.43 ± 0.31	-5.585	< 0.001
升主动脉直径（cm）	观察组对照组	3.04 ± 0.52 3.08 ± 0.41	0.326	0.745
rPA	观察组对照组	1.03 ± 0.25 0.79 ± 0.98	-4.437	< 0.001

指标	组别	测量值	t/Z值	P值
IL-2	观察组对照组	1.08 ± 0.80 1.36 ± 1.03	1.160	0.250
IL-4^a	观察组对照组	0.59（0.18，1.48） 0.73（0.27，1.61）	-0.597	0.551
IL-6^a	观察组对照组	23.13（5.66，56.35） 22.22（6.83，78.00）	-0.192	0.848
IL-10^a	观察组对照组	5.34（3.24，9.95） 6.25（2.97，12.17）	-0.165	0.869
TNF-α	观察组对照组	1.22 ± 0.70 0.74 ± 0.48	-2.950	0.006
IFN-γ^a	观察组对照组	2.00（0.97，12.50） 2.92（0.42，6.68）	-0.309	0.758

参数指标	TNF-α
参数指标	r值	P值
PA	0.216	0.084
dPA	0.320	0.009
升主动脉管径	-0.024	0.849
rPA	0.310	0.012

参数指标	HIV-PAH
参数指标	r值	P值
PA	0.501	< 0.001
dPA	0.632	< 0.001
升主动脉管径	-0.041	0.745
rPA	0.572	< 0.001
TNF-α	0.381	0.002

指标	AUC	约登指数	P值	95%CI	敏感度（%）	特异度（%）
单项指标
PA	0.799	0.494	< 0.01	0.677 ~ 0.922	56.5	92.9
dPA	0.860	0.640	< 0.001	0.755 ~ 0.964	78.3	85.7
rPA	0.847	0.687	< 0.001	0.728 ~ 0.966	78.3	90.5
TNF-α	0.713	0.430	0.005	0.575 ~ 0.852	73.9	69.0
联合指标
TNF-α+dPA+rPA	0.891	0.751	< 0.001	0.790 ~ 0.992	87.0	88.1

Research on the diagnostic value of pulmonary artery diameter characteristics and combined TNF-α in patients with HIV associated pulmonary hypertension

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