大内皮素1对心脏再同步治疗患者临床预后的评估作用  

Big endothelin-1 and long-term clinical outcomes in heart failure patients receiving cardiac resynchroni- zation therapy

作　　者：糜家睿[1] 刘志敏[1] 杨绳文 华伟[1] 陈柯萍[1] 丁立刚[1] 张澍[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心心血管疾病国家重点实验室阜外医院心律失常中心,100037

出　　处：《中华心律失常学杂志》2015年第6期411-415,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：国家科技支撑计划

摘　　要：目的探讨大内皮素1（big ET—1）对接受心脏再同步治疗（CRT）的心力衰竭（心衰）患者全因死亡和心衰再住院的风险评估作用。方法回顾性调查阜外医院心律失常中心2010年1月至2014年12月行首次CRT植入的249例心衰患者临床资料，对所有患者行电话随访。定义随访终点为全因死亡（包括心脏移植）和心衰再住院。以1年内全因死亡为因变量绘制受试者工作特征（ROC）曲线，根据Youden指数（敏感度＋特异度-1）最大值找到bigET-1的最佳诊断界值。将患者分为big ET-1≥界值组与bigET-1〈界值组，比较两组患者基线资料并行相关性分析；对随访结果做生存分析和Cox回归分析以评价bigET-1对各临床终点的风险评估作用。结果相关性分析显示，bigET-1与超敏C反应蛋白（hsCRP）、N末端脑钠肽前体对数值（LgNT—proBNP）、左心房内径（LAD）和左心室舒张末期内径（LVEDD）呈正相关（r=0．207，P=0．001；r=0．337，P〈0．0001；r=0．275，P〈0．0001；r=0．131，P=0．038）。ROC曲线分析显示，预测患者1年内全因死亡的bigET-1最佳诊断界值为0．565pmol／L，（P〈0．0001，曲线下面积0．722，敏感度0．750，特异度0．620）。Kaplan—Meier生存分析显示bigET-1≥0．565pmol／L组在全因死亡和心衰再人院方面均劣于bigET-1〈0．565pmol／L组（P=0．002，P〈0．0001）。单因素及多因素Cox回归分析显示，bigET-1≥0．565pmol／L是CRT患者全因死亡（HR2．331．95％CI1．060—5．125，P=0．035）和心衰再住院（HR2．662，95％CI1．599—4．432，P〈0．0001）的独立危险因素。结论bigET-1与CRT患者的心衰严重程度相关。基线bigET-1≥10．565pmol／L提示患者接受CRT的全因死亡率和心衰再住院风险增加。Objective The goal of this study was to evaluate the role of big endothelin-1 （ big ET-1 ） as a prognostic marker in heart failure （HF） patients receiving cardiac resynchronization therapy （CRT）. Methods In this single-center retrospective cohort study,a total of 249 patients which had CRT implantation from January 2010 to December 2014 with chronic heart failure （CHF） were enrolled. Clinical outcomes were defined as all-cause mortality （including heart transplantation） and new hospitalization due to worsening HF. Receiver operating characteristic （ROC） curve was performed to determine the cut-off value of big ET-1 in pre- dicting one-year all-cause mortality. All patients were divided into two groups according to the cut-off value. Pearson＇ s bivariate correlation tests were performed to evaluate the relations between big ET-1 and other clini- cal variables. Kaplan-Meier survival analyses for each outcome were analyzed. Finally, Cox proportional-hazards regression model was used to determine whether big ET-1 was an independent prognostic factor in CRT treated patients. Results The median follow-up time was 23 months. Twenty-five patients （ 10.0% ） died,6 patients （2.4%） underwent heart transplantation and 65 patients （26. 1% ） experienced at least one HF readmission. Taking the cut-off value of big ET-1 （0. 565 pmol/L） by ROC curve,patients with big ET-1 ≥0. 565 pmol/L had higher level of serum creatinine, uric acid, high sensitive C reactive protein （hsCRP）, left atrial diameter （LAD） , left ventricular end-diastolic diameter （LVEDD）, left ventricular ejection fraction and New York Heart Association （NYHA） functional class with higher incidence of atrial fibrillation. The correlation analyses indi- cated that big ET-1 was positively associated with LgNT-proBNP, hsCRP, LAD and LVEDD （ r = 0. 207, P = 0. 001 ;r=0. 337 ,P〈0. 0001 ;r=0. 275 ,P〈0. 0001 ;r=0. 131 ,P=0. 038, respectively）. Kaplan-Meier analyses demonstrated that the big ET-1 I〉0. 56

关 键 词：大内皮素1 心力衰竭 心脏再同步治疗 危险因素 预后 

分 类 号：R541.6[医药卫生—心血管疾病]