主动脉弹性参数联合血浆Apelin评估二叶式主动脉瓣畸形主动脉扩张的临床价值

Aortic Elasticity Parameters Combined with Plasma Apelin to Evaluate the Clinical Value of Aortic Dilation in Bicuspid Aortic Valve

摘要: 目的：探讨主动脉弹性参数联合血浆apelin在评估二叶式主动脉瓣畸形主动脉扩张的临床应用价值。方法：此研究包括64例无明显瓣膜功能障碍的BAV患者，并根据经体表面积校正的主动脉内径大小分为两个亚组：主动脉直径 < 40 mm，或者ASI < 22 mm/m2 (BAV I组，主动脉未扩张组，33例)和主动脉直径 ≥ 40 mm，或者ASI > 22 mm/m2 (BAV II组，主动脉扩张组，31例)，同期纳入33例三叶式瓣主动脉瓣对照受试者。采用二维经胸心声心动图测量和评估各研究对象升主动脉内径及弹性参数(主动脉应变、主动脉僵硬度指数)。ELISA法检测血浆apelin水平。应用Pearson相关分析法分析主动脉弹性参数与血浆apelin的相关性；绘制受试者工作特征(ROC)曲线分析主动脉弹性参数联合、血浆apelin及三者总联合评估二叶式主动脉瓣畸形主动脉扩张的临床价值。结果：在多组比较中，BAV I组、II组的升主动脉内径及主动脉僵硬指数均显著高于对照组，而主动脉应变及血浆apelin水平均显著低于对照组，差异均有统计学意义(均P < 0.05)。BAV II组的升主动脉内径及主动脉僵硬指数显著高于BAV I组，而升主动脉应变及血浆apelin水平显著低于BAV I组，差异有统计学意义(均P < 0.05)。Pearson相关性分析显示，BAV组血浆apelin水平与升主动脉应变率与呈正相关(r = 0.197, P < 0.05)，与升主动脉内径、升主动脉僵硬指数呈负相关(r = −0.284，−0.174，均P < 0.05)。ROC曲线分析显示，主动脉僵硬指数、主动脉应变率、血浆apelin及三者总联合评估二叶式主动脉瓣畸形主动脉扩张的曲线下面积分别为0.857、0.891、0.753、0.909，敏感性分别为87%、74%、65%、84%，特异性分别为76%、94%、82%、85%。结论：主动脉弹性指标及血浆apelin的联合应用能较好地评估BAV患者主动脉扩张，将对临床治疗具有重大意义。

Abstract: Objective: To explore the clinical application value of aortic elasticity parameters combined with plasma apelin in the evaluation of aortic dilation in bicuspid aortic valve. Methods: This study in-cluded 64 patients with BAV without significant valvular dysfunction and divided them into two subgroups based on the size of the aortic diameter adjusted for body surface area: Aortic diameter < 40 mm, or ASI < 22 mm/m2 (BAV group I, non-aortic dilation group, 33 cases) and aortic diameter ≥ 40 mm, or ASI > 22 mm/m2 (BAV group II, aortic dilation group, 31 cases) were included in 33 control subjects with trilobated aortic valves. The inner diameter and elastic parameters (aortic strain and aortic stiffness index) of ascending aorta were measured and evaluated by two-dimensional transthoracic echocardiography. Plasma apelin level was detected by ELISA. The correlation between aortic elastic parameters and plasma apelin was analyzed by Pearson correla-tion analysis. The receiver operating characteristic (ROC) curve was plotted to analyze the aortic elasticity parameter combination, plasma apelin and the total combination of the three to evaluate the clinical value of aortic dilation in bicuspid aortic valve. Results: In the multi-group comparison, the ascending aorta inner diameter and aortic stiffness index of BAV group I and II were signifi-cantly higher than those of control group, while the aortic strain and plasma apelin level were sig-nificantly lower than those of control group, with statistical significance (all P < 0.05). The ascending aortic diameter and aortic stiffness index in BAV II group were significantly higher than those in BAV I group, while the ascending aortic strain and plasma apelin level were significantly lower than those in BAV I group, with statistical significance (all P < 0.05). Pearson correlation analysis showed that plasma apelin level in BAV group was positively correlated with ascending aorta strain (r = 0.197, P < 0.05), and negatively correlated with ascending aorta diameter and ascending aorta stiffness index (r = −0.284, −0.174, both P < 0.05). ROC curve analysis showed that the area under the curve of aortic elasticity index, aortic strain rate, plasma apelin and their combined prediction of aortic dilatation were 0.857, 0.891, 0.753 and 0.909, and the sensitivity was 87%, 74%, 65% and 84%. The specificity was 76%, 94%, 82% and 85%. Conclusion: The combination of aortic elasticity index and plasma apelin can better evaluate aortic dilation in BAV patients, which will be of great significance for clinical treatment.