Relationship Between Pulmonary Arterial Pressure And Plasma STWEAK Of Children With Congenital Heart Disease

Objective: To explore the pathogenesis of soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK)and pulmonary arterial hypertension assosiated congenital heart disease(PAH-CHD),we detected the concentration of sTWEAK in peripheral blood of children with congenital heart disease(CHD),hoping to provide a new clinical basis for the diagnosis and prognostic assessment of children with PAH-CHD.Methods:A total of 69 children with CHD who were hospitalized in the Department of Cardiology Surgery or the Department of Cardiac Intensive Medicine of the Affiliated Hospital of Jining Medical Uniwersity from November 2017 to August 2018 were collected.All the selected children were diagnosed as left-to-right shunt CHD by strict physical examination and echocardiography.Collect general clinical data of all cases,use enzyme-linked immunosorbent assay(ELISA)to detect the plasma sTWEAK concentration,and analyze its relationship with the the prognosis of children with PAH-CHD.Results: The subjects included in this study were 69 children with CHD,whose sTWEAK levels in peripheral blood were not correlated with gender composition,age,height,and weight(P> 0.05).Among them,the level of plasma sTWEAK in children without PAH was higher than that in mild PAH group,moderate PAH group and severe PAH group(P=0.010,P= 0.000,P=0.000);the level of plasma sTWEAK in children with mild PAH was higher than that in moderate PAH group and severe PAH group(P=0.020;P=0.000);the plasma sTWEAK level of children in the moderate PAH group trended to be higher than that in the severe PAH group,but there was no statistical significance(P=0.079).There was a statistically negative correlation between plasma sTWEAK level and mPAP in children with PAH-CHD(r=-0.742,P<0.0001).There was a statistically significant positive correlation between the plasma sTWEAK level and PaO2 in children(r=0.666,P<0.0001);the peripheral blood sTWEAK level in children had a statistically negative correlation with the hospital stay(r=-0.566,P<0.0001);the peripheral blood sTWEAK level in children had a statistically negative correlation with the ICU time of the children(r=-0.511,P<0.0001);children Peripheral blood sTWEAK level had a statistically negative correlation with the length of tracheal intubation(r=-0.632,P<0.0001);the plasma sTWEAK level in children with CHD had a statistically positive correlation with the score of APACHE II(r=0.732,P<0.0001);the plasma sTWEAK level in children with CHD had a statistically negative correlation with the level of lactic acid on the first day of admission(r=-0.549,P<0.0001).The diagnostic ability of plasma sTWEAK level in children with CHD: cut-off value is410.5pg/ml,the area under the curve is 0.83,the sensitivity is 90.74%,the specificity is 73.33%,P=0.0001.Compared with the concentration ofsTWEAKs in children before surgery,the concentration after surgery had increased significantly(166.00 ± 87.88 pg/ml,P=0.029,n=18).Conclusion:As a new biomarker in recent years,sTWEAK has been proved to exist widely in the cardiovascular system.Different authors have demonstrated through independent experiments that plasma sTWEAK concentration decreases in patients with cardiovascular disease or cardiovascular-related diseases.We determined by ELISA that in children with PAH-CHD,sTWEAK levels decreased as the pulmonary artery pressure increases.sTWEAK has value in diagnosing the severity of PAH-CHD in children and judging the prognosis of the children.Especially for the early stage of congenital heart disease with normal pulmonary artery pressure value,sTWEAK can make a judgment earlier than imaging examination.