School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China.
Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2024 Jun 4;19:1233-1245. doi: 10.2147/COPD.S448496. eCollection 2024.
Smoking is a major risk factor for the group 3 PH. NT-proBNP is a biomarker for risk stratification in PH. This study aims to investigate the effects of smoking status and smoking index (SI) on group 3 PH and to evaluate the value of SI and SI combined with NT-proBNP in early diagnosis and prediction of disease severity.
Four hundred patients with group 3 PH at the First Hospital of Shanxi Medical University between January 2020 and December 2021 were enrolled and divided into two groups: mild (30 mmHg ≤ pulmonary artery systolic pressure (PASP)≤50 mmHg) and non-mild (PASP >50 mmHg). The effect of smoking on group 3 PH was analyzed using univariate analysis, and logistic analysis was conducted to evaluate the risk of group 3 PH according to smoking status and SI. Spearman correlation coefficient was used to test the correlation between SI and the index of group 3 PH severity. The predictive value of SI was evaluated using a receiver operating characteristic (ROC) curve.
Correlation and logistic analyses showed that SI was associated with PH severity. Smoking status =0.009) and SI (=0.039) were independent risk factors for non-mild group 3 PH, and ROC showed that the predictive value of SI (AUC:0.596) for non-mild PH was better than that of the recognized pro-brain natriuretic peptide (NT-proBNP) (AUC:0.586). SI can be used as a single predictive marker. SI and NT-proBNP can be formulated as prediction models for screening non-mild clinical cases (AUC:0.628).
SI is a potentially ideal non-invasive predictive marker for group 3 PH. SI and NT-proBNP could be used to develop a prediction model for screening non-mild PH cases. This can greatly improve the predictive specificity of the established PH marker, NT-proBNP.
吸烟是 3 组肺动脉高压（PH）的主要危险因素。NT-proBNP 是 PH 风险分层的生物标志物。本研究旨在探讨吸烟状况和吸烟指数（SI）对 3 组 PH 的影响，并评估 SI 及其与 NT-proBNP 联合应用在早期诊断和预测疾病严重程度方面的价值。
选取 2020 年 1 月至 2021 年 12 月山西医科大学第一医院收治的 400 例 3 组 PH 患者，分为轻度组（30mmHg≤肺动脉收缩压（PASP）≤50mmHg）和非轻度组（PASP＞50mmHg）。采用单因素分析评估吸烟对 3 组 PH 的影响，采用逻辑分析评估根据吸烟状况和 SI 评估 3 组 PH 的风险。采用斯皮尔曼相关系数检验 SI 与 3 组 PH 严重程度指标的相关性。采用受试者工作特征（ROC）曲线评估 SI 的预测价值。
相关性和逻辑分析表明，SI 与 PH 严重程度相关。吸烟状态（OR=2.154，95%CI：1.016～4.543，P=0.046）和 SI（OR=2.532，95%CI：1.104～5.834，P=0.025）是非轻度 3 组 PH 的独立危险因素。ROC 显示，SI（AUC：0.596）对非轻度 PH 的预测价值优于公认的脑利钠肽前体（NT-proBNP）（AUC：0.586）。SI 可作为单一预测标志物。SI 和 NT-proBNP 可作为筛选非轻度临床病例的预测模型（AUC：0.628）。
SI 是 3 组 PH 潜在的理想无创预测标志物。SI 和 NT-proBNP 可用于建立筛选非轻度 PH 病例的预测模型。这可以极大地提高已建立的 PH 标志物 NT-proBNP 的预测特异性。
