循环组织型金属蛋白酶抑制剂4与可溶性E选择素联合检测对慢性心力衰竭病情及预后的评估价值  

Prognostic value of the combination of TIMP-4 and sES in patients with chronic heart failure

作　　者：黄洁[1] 杨海英[1] 王德伟[1] 石惠荣[1] 刘国红[1] 

机构地区：[1]唐山市丰润区人民医院心内二科,064000

出　　处：《中国心血管杂志》2017年第2期121-125,共5页Chinese Journal of Cardiovascular Medicine

摘　　要：目的评估动态检测循环组织型金属蛋白酶抑制剂4(TIMP-4)与可溶性E选择素(s ES)水平对判断慢性心力衰竭(CHF)患者的病情及预后的临床价值。方法选择我院112例确诊CHF患者为研究对象,根据纽约心脏病学会(NYHA)心功能分级分为两组:重度组,42例,NYHAⅢ~Ⅳ级;轻度组,70例,NYHAⅠ~Ⅱ级。分别在临床治疗第1、2、4和6个月检测两组患者血浆N末端B型利钠肽原(NT-proBNP)、TIMP-4和s ES水平,并进行比较。随访1年,比较两组患者的生存率。应用多元Logistic回归分析上述各循环指标与CHF患者1年生存率的相关性。结果在同一时间点,重度组患者的血浆NT-proBNP与s ES水平高于轻度组(均为P<0.05),而TIMP-4水平较低(均为P<0.05)。随治疗时间延长,两组患者血浆NT-proBNP与s ES均逐渐降低,而TIMP-4水平逐渐升高(均为P<0.05)。随访1年,重度组的生存率显著低于轻度组(χ~2=10.536,P=0.036)。多元Logistic回归分析显示,NT-proBNP与s ES为CHF的正相关因素(β=0.595,P=0.026;β=0.788,P=0.016),而TIMP-4为CHF的负相关因素(β=-0.697,P=0.038)。结论血浆TIMP-4与sES联合动态检测对评估慢性心力衰竭的严重程度和预测预后有一定的临床价值。Objective To evaluate the prognostic value of the dynamic variation of plasma levels of tissue-type metalloproteinase inhibitor 4（TIMP-4） and soluble E-selectin（sES） in patients with chronic heart failure（CHF）. Methods The 112 CHF patients were enrolled and divided into two groups according to New York Heart Association（NYHA） classification. There were 42 cases in severe group with NYHA level llI-IV and 70 cases in mild group with NYHA level I - II. The plasma levels of NT-proBNP, TIMP-4 and sES were tested and compared at 1st, 2rd, 4th, 6th month post-therapy respectively. Survival rates were compared atone year post-therapy follow-up. Logistic analysis was used to analyzing the relationship between survival rate and the levels of above markers. Results Compared with mild group, the plasma levels of NT-proBNP and sES in severe group was higher（ all P 〈 0.05 ）, but the plasma level of TIMP-4 was lower（ P 〈 0. 05 ）. With the prolonged treatment time, the plasma levels of NT-proBNP and sES both decreased in two groups （ all P 〈 0. 05 ）, but TIMP-4 increased in two groups. One year follow-up data showed the survival rates in severe group were lower than mild group（x2 = 10. 536, P = 0. 036 ）. Multivariant Logistic analysis showed that NT-proBNP and sES levels were positively correlated with survival rate of CHF（β = 0. 595 ,P = 0. 026; β = 0. 788,P = 0. 016） ,while TIMP-4 level was negatively correlated factor to the survival rate of CHF （β = -0. 697, P = 0. 038 ）. Conclusions Serum TIMP-4 and sES levels have some prognostic value for evaluation of degree of CHF.

关 键 词：心力衰竭 组织型金属蛋白酶抑制剂4 可溶性E选择素 预后 

分 类 号：R541.6[医药卫生—心血管疾病]