血清sST2、apelin和CPP水平与心力衰竭患者预后的相关性分析  

Correlation analysis between serum levels of sST2,apelin,and CPP and the prognosis of heart failure

作　　者：余鹏[1,2,3] 曾文飞 林凯玲 余惠珍 Y Peng;ZENG Wen-fei;LIN Kai-ling;Y Hui-zhen(Provincial Clinical Medical College of Fujian Medical University,Fuzhou 350001,Fujian,China;Department of Medicine,Fujian Provincial Hospital South Branch(Fujian Provincial Jinshan Hospital),Fuzhou 350001,Fujian,China;Fujian Provincial Hospital Key Laboratory of Geriatric Medicine,Fuzhou 350001,Fujian,China)

机构地区：[1]福建医科大学省立临床医学院,福州350001 [2]福建省立医院南院(福建省立金山医院)内科,福州350001 [3]福建省老年病重点实验室,福州350001

出　　处：《中国临床医学》2021年第4期581-587,共7页Chinese Journal of Clinical Medicine

基　　金：国家自然科学基金(81873515);福建省自然科学基金(2020J011072);福建省卫生计生青年科研课题(20170132);福建省立医院“创双高”火石基金(2020HSJ03).

摘　　要：目的:分析血清可溶性生长刺激表达基因2蛋白(sST2)、apelin及和肽素(CPP)水平与不同射血分数心力衰竭患者预后的相关性。方法:选择2018年11月至2020年5月在福建省立金山医院诊断为心力衰竭的119例患者,根据左室射血分数,将其分为射血分数降低组(HFrEF组,n=31)、射血分数中间值组(HFmrEF组,n=21)和射血分数保留组(HFpEF组,n=67)。检测3组患者血清中N末端脑钠肽前体(NT-proBNP)、sST2、apelin和CPP的含量。所有患者入院后根据指南规范化治疗心力衰竭,随访2年,分析各心脏生物学标志物与心血管死亡之间的关系。结果:3组间患者性别、收缩压、脉压、体质量指数、尿素氮、糖化血红蛋白、左心室舒张末期内径、右心房横径、右心室舒张末期内径差异均有统计学意义(P<0.05)。3组患者血清中NT-proBNP和sST2含量差异有统计学意义(P<0.05),CPP和apelin含量差异无统计学意义。多元线性模型分析结果显示,血清NT-proBNP水平与左室射血分数相关(F=3.49,P=0.03),而血清sST2、apelin、CPP水平与左室射血分数无相关性。随访24个月时HFrEF组、HFmrEF组、HFpEF组患者累计心血管死亡率分别为29.0%、23.8%、10.4%,差异有统计学意义(P=0.04)。Kaplan-Meier生存分析显示,HFrEF、HFmrEF、HFpEF组心血管病累计生存率依次升高(χ^(2)=6.48,P=0.04)。Cox回归分析结果显示,NT-proBNP、尿素氮水平及使用盐皮质激素受体拮抗剂是心力衰竭患者心血管死亡的独立影响因素(P<0.01)。结论:左室射血分数、NT-proBNP、尿素氮水平及使用盐皮质激素受体拮抗剂对心力衰竭患者心血管死亡有预测作用,而血清sST2、apelin和CPP水平预测价值有限。Objective:To analyze the correlation between multiple cardiac biomarkers(sST2,apelin,and CPP)and the prognosis of patients with heart failure(HF)with different ejection fractions(EFs).Methods:A total of 119 patients with HF admitted to Fujian Jinshan Hospital from November 2018 to May 2020 were included.Patients were divided into 3 groups according to the left ventricular EF:the heart failure with reduced EF(HFrEF)group(n=31),the heart failure with middle-range EF(HFmrEF)group(n=21),and the heart failure with preserved EF(HFpEF)group(n=67).The novel serum biomarkers including N-terminal pro-brain natriuretic peptide(NT-proBNP),soluble suppression of tumorigenicity-2(sST2),apelin,and copeptin(CPP)were detected.All patients were treated with the standard therapies.All patients were followed up for 2 years until the cardiovascular death.The relationships between cardiac biomarkers and cardiovascular death were analyzed.Results:There were statistically significant differences in gender,systolic blood pressure,pulse pressure,body mass index,urea nitrogen,glycosylated hemoglobin,left ventricle end-systolic diameter,transverse right atrium diameter,and right ventricular end-systolic diameter among different EF groups(P<0.05).There were statistically significant differences in NT-proBNP and sST2 among different EF groups(P<0.05),however,no difference in CPP and apelin were observed.Multivariate general linear model analysis showed that there was correlations in NT-proBNP level and EF(F=3.49,P=0.03),while there was no significant difference in levels of sST2,apelin,and CPP.Within 24 months of follow-up,the accumulated cardiovascular mortality of patients in HFrEF,HFmrEF,and HFpEF groups was 29.0%,23.8%,and 10.4%,respectively,and the difference had statistically significant(P=0.04).Kaplan-Meier survival curves analysis results showed that cumulative surval rate in HFrEF,HFmrEF,and HFpEF groups increased in sequence(χ^(2)=6.48,P=0.04).Cox regression analysis results showed that NT-proBNP,urea nitrogen,and taking mineraloco

关 键 词：心力衰竭 射血分数 N末端脑钠肽前体 可溶性生长刺激表达基因2蛋白 和肽素 APELIN 

分 类 号：R543.3[医药卫生—心血管疾病]