血清PlGF和sFlt-1评估慢性心力衰竭患者心功能分级的临床价值研究  

Clinical value of serum PlGF and sFlt-1 to review of heart function classification in patients with chronic heart failure

作　　者：彭雪[1] 王文娟[1] 赵莉 宋坤青[1] 赵殿儒 Peng Xue;Wang Wenjuan;Zhao Li;Song Kunqing;Zhao Dianru(Department of Geriatrics,Central Hospital of Cangzhou City,Hebei Province,Cangzhou 061000,China;不详)

机构地区：[1]沧州市中心医院老年内科,沧州061000 [2]沧州市人民医院心内三科,沧州061000

出　　处：《中国循证心血管医学杂志》2020年第12期1465-1469,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河北省沧州市科技支撑计划项目(162302162)。

摘　　要：目的探讨血清胎盘生长因子(PlGF)及可溶性fms样酪氨酸激酶受体1(sFlt-1)对于评估慢性心力衰竭(CHF)患者心功能分级的价值以及影响因素。方法选择2018年1月至2019年1月间于沧州市中心医院老年内科确诊并接受治疗的缺血性心力衰竭患者100例,另外选择60例健康志愿者作为健康对照组,比较两组患者血清PlGF和sFlt-1水平的差异。另外分析血清PlGF和sFlt-1水平以及PlGF/sFlt-1比值与CHF患者NYHA心功能分级、血浆N末端脑钠肽前体(NT-proBNP)含量、左室射血分数(LVEF)的相关性。并采用受试者工作特征(ROC)曲线和多因素Logistic回归模型分析血清PlGF和sFlt-1水平、PlGF/sFlt-1比值的诊断价值。结果CHF患者血清PlGF、sFlt-1基线水平明显高于健康对照组受试者,且PlGF/sFlt-1比值低于健康对照组受试者(P<0.05)。经多因素Logistic回归分析,校正各项混杂因素后,PlGF是CHF发生的独立危险因素,且PlGF/sFlt-2是CHF发生的独立保护因素(P<0.05)。与Ⅱ级CHF患者相比,Ⅲ~Ⅳ级CHF患者血清PlGF和sFlt-1水平升高,而PlGF/sFlt-1比值则降低(P<0.05)。经Pearson相关性分析,CHF患者血清PlGF水平和PlGF/sFlt-2比值与NT-proBNP、LVEF都具有显著的相关性(P<0.05)。PlGF+sFlt-1+PlGF/sFlt-1比值诊断Ⅲ~Ⅳ级CHF的ROC曲线下的面积为0.811(95%CI:0.731~0.876,P<0.001)。结论CHF患者血清PlGF和sFlt-1水平较健康对照组升高,而PlGF/sFlt-1比值则降低,对于Ⅲ~Ⅳ级CHF具有良好地诊断效能。Objective To investigate the value and influence factors of serum placental growth factor(PlGF)and soluble fms-like tyrosine kinase 1 receptor(sFlt-1)in review of heart functional classification in patients with chronic heart failure(CHF).Methods The patients(n=100,CHF group)and healthy controls(n=60,healthy control group)were chosen from Department of Geriatrics in Central Hospital of Cangzhou City from Jan.2018 to Jan.2019.The levels of serum PlGF and sFlt-1 were compared between 2 groups.The correlation among PlGF level,sFlt-1 level,ratio of PlGF to sFlt-1(PlGF/sFlt-1 ratio),NYHA classification of heart function,NT-proBNP and LVEF were analyzed.The diagnostic value of PlGF level,sFlt-1 level and PlGF/sFlt-1 ratio was analyzed by applying ROC curve and multi-factor Logistic regression model.Results The baseline levels of PlGF and sFlt-1 were significantly higher,and PlGF/sFlt-1 ratio was lower in CHF group than those in healthy control group(P<0.05).The results of multi-factor Logistic regression analysis showed that,after corrected different confounding factors,PlGF was an independent risk factor of CHF,and PlGF/sFlt-2 was an independent protective factor of CHF(P<0.05).PlGF level and sFlt-1 level increased and PlGF/sFlt-1 ratio decreased in CHF patients with NYHA gradesⅢ-Ⅳcompared with CHF patients with NYHA gradeⅡ(P<0.05).The results of Pearson correlation analysis showed that PlGF level and PlGF/sFlt-2 were significantly correlated to NT-proBNP and LVEF(P<0.05).The area under ROC curve was 0.811(95%CI:0.731~0.876,P<0.001)in the diagnosis of NYHA gradesⅢ-Ⅳby PlGF+sFlt-1+PlGF/sFlt-1 ratio.Conclusion The levels of serum PlGF and sFlt-1 are higher and PlGF/sFlt-1 ratio is lower in CHF patients than those in healthy people,which has a higher diagnostic efficacy to NYHA grades III-IV of CHF.

关 键 词：胎盘生长因子 可溶性fms样酪氨酸激酶受体1 PlGF/sFlt-1比值 慢性心力衰竭 NYHA心功能分级 

分 类 号：R541.61[医药卫生—心血管疾病]