血清脑源性神经营养因子水平与左心室射血分数降低的心力衰竭患者预后的关系研究  

Relationship between Serum BDNF Level and Prognosis in Patients with Heart Failure with Reduced Ejection Fraction

作　　者：程小兵 罗娟娟[2] 陈燕 潘文博 钟万生 韩卫星[3] CHENG Xiaobing;LUO Juanjuan;CHEN Yan;PAN Wenbo;ZHONG Wansheng;HAN Weixing(Department of Cardiovascular Internal Medicine,the Third People's Hospital of Hefei/Anhui Medical University Hefei Third Clinical College,Hefei 230001,China;Department of Physiology,Gannan Medical College,Ganzhou 341000,China;Department of Cardiovascular Internal Medicine,the First Affiliated Hospital of Anhui Medical University,Hefei 230001,China)

机构地区：[1]安徽省合肥市第三人民医院安徽医科大学合肥第三临床学院心血管内科,230001 [2]赣南医学院生理教研室,江西省赣州市341000 [3]安徽医科大学第一附属医院心血管内科,安徽省合肥市230001

出　　处：《实用心脑肺血管病杂志》2021年第10期29-35,41,共8页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：合肥市第三人民医院重点课题(SYKZ202002);合肥市第三人民医院重点扶持课题(SYKF201902);江西省教育厅青年基金项目(GJJ161004)。

摘　　要：背景心力衰竭(HF)是一种复杂的进行性临床综合征,发病率、死亡率及住院率均较高。有研究表明,脑源性神经营养因子(BDNF)与心血管疾病有关,但目前临床关于BDNF水平对射血分数降低的心力衰竭(HFrEF)患者预后的影响罕有报道。目的探讨血清BDNF水平与HFrEF患者预后的关系。方法选取合肥市第三人民医院心血管内科2019年1月至2020年5月收治的HFrEF患者160例。随访12个月,将发生心血管死亡患者分为死亡组,未发生心血管死亡患者分为存活组;将发生HF恶化再住院患者分为再住院组,未发生HF恶化再住院患者分为未再住院组。收集患者的临床资料。采用多元Cox比例风险回归分析探讨HFrEF患者随访12个月发生心血管死亡或HF恶化再住院的影响因素。绘制受试者工作特征(ROC)曲线以评价血清BDNF水平对HFrEF患者随访12个月发生心血管死亡或HF恶化再住院的预测价值。结果随访12个月,发生心血管死亡29例、HF恶化再住院118例,心血管死亡率为18.12%(29/160),HF恶化再住院率为73.75%(118/160)。死亡组患者年龄大于存活组,缺血性心肌病、糖尿病、慢性肾脏病发生率,肺动脉收缩压(PASP)、左心室质量指数、血肌酐及血清C反应蛋白(CRP)、肌钙蛋白、脑钠肽(BNP)水平高于存活组,左心室射血分数(LVEF)、血清BDNF水平低于存活组(P<0.05)。再入院组患者年龄大于未再住院组,PASP、左心室质量指数及血清CRP、BNP水平高于未再入院组,收缩压、LVEF、血肌酐、K+及血清肌钙蛋白、BDNF水平低于未再住院组(P<0.05)。多元Cox比例风险回归分析结果显示,缺血性心肌病、糖尿病、慢性肾脏病、LVEF、血肌酐及血清CRP、肌钙蛋白、BNP、BDNF水平是HFrEF患者随访12个月发生心血管死亡的独立影响因素(P<0.05);PASP及血清CRP、BNP、BDNF水平是HFrEF患者随访12个月发生HF恶化再住院的独立影响因素(P<0.05)。ROC曲线分析结果显示,�Background Heart failure(HF)is a complex progressive clinical syndrome with high morbidity,mortality and hospitalization rate.Studies have shown that brain-derived neurotrophic factor(BDNF)is related to cardiovascular diseases,but there are few reports about the impact of BDNF level on the prognosis in patients with heart failure with reduced ejection fraction(HFrEF).Objective To explore the relationship between serum BDNF level and prognosis in patients with HFrEF.Methods A total of 160 patients with HFrEF were selected in the Department of Cardiovascular Internal Medicine of the Third People's Hospital of Hefei from January 2019 to May 2020.The patients were followed up for 12 months,patients with cardiovascular death were divided into death group and patients without cardiovascular death were divided into survival group;patients with HF deterioration rehospitalization were divided into rehospitalization group,and patients without HF deterioration rehospitalization were divided into non-rehospitalization group.Clinical data of patients were collected,and multivariate Cox proportional hazards regression analysis was used to explore the influencing factors of cardiovascular death or HF deterioration rehospitalization in patients with HFrEF.Receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of serum BDNF level for cardiovascular death or HF deterioration rehospitalization in HFrEF patients after 12 months of followup.Results After 12 months of follow-up,29 cases occurred cardiovascular death and 118 cases occurred HF deterioration rehospitalization.The cardiovascular mortality rate was 18.12%(29/160),and the HF deterioration rehospitalization rate was 73.75%(118/160).Age of death group was older than that of survival group,incidence of ischemic cardiomyopathy,diabetes,chronic kidney disease,pulmonary artery systolic pressure(PASP),left ventricular mass index,serum creatinine and serum levels of C-reactive protein(CRP),cardiac troponin,brain natriuretic peptide(BNP)were higher th

关 键 词：心力衰竭 射血分数降低型心力衰竭 脑源性神经营养因子 影响因素分析 

分 类 号：R541.6[医药卫生—心血管疾病]