血清NRG-1、sSema4D水平与老年急性失代偿性心力衰竭患者短期预后的关系  

Relationships between serum NRG-1,sSema4D,and short-term prognosis in elderly patients with acute decompensated heart failure

作　　者：钟素 余研 吴永鑫 ZHONG Su;YU Yan;WU Yongxin(Cadre Ward,Chenggong Hospital Affiliated to Xiamen University,Fujian 361000,China;不详)

机构地区：[1]厦门大学附属成功医院干部病房,福建厦门361000 [2]南安市海都医院外科

出　　处：《山东医药》2022年第4期1-5,共5页Shandong Medical Journal

基　　金：福建省卫生计生科研人才培养项目(2018-2-88)。

摘　　要：目的探讨血清神经调节蛋白1(NRG-1)、可溶性信号素4D(sSema4D)水平与老年急性失代偿性心力衰竭(ADHF)患者短期预后的关系。方法选取225例老年ADHF患者为ADHF组,74例纽约心脏病协会(NYHA)分级Ⅰ~Ⅱ级老年CHF患者为CHF组,78例体检健康者为对照组。采用ELISA检测血清NRG-1、sSema4D,分析老年ADHF患者血清NRG-1、sSema4D水平与左心室射血分数(LVEF)、N末端B型钠尿肽前体(NT-proBNP)的相关性,采用多因素Logistic回归分析老年ADHF患者短期预后不良影响因素,采用受试者工作特征(ROC)曲线分析血清NRG-1、sSema4D水平对老年ADHF患者短期预后不良的预测价值。结果与CHF组和对照组比较,ADHF组血清NRG-1水平降低,sSema4D水平升高(P均<0.05);与对照组比较,CHF组血清NRG-1水平降低,sSema4D水平升高(P均<0.05)。老年ADHF患者血清NRG-1水平与LVEF呈正相关,与NT-proBNP呈负相关(r分别为0.602、-0.588,P均<0.001);sSema4D水平与LVEF呈负相关,与NT-proBNP呈正相关(r分别为-0.587、0.614,P均<0.001)。NYHA分级Ⅳ级(OR=1.019,95%CI:1.002~1.036)、NT-proBNP(OR=1.174,95%CI:1.024~1.347)、sSema4D(OR=1.163,95%CI:1.037~1.305)为老年ADHF患者短期预后不良的独立危险因素,LVEF(OR=0.795,95%CI:1.024~1.347)、NRG-1(OR=0.813,95%CI:0.733~0.903)为独立保护因素(P均<0.05)。NRG-1、sSema4D、NRG-1+sSema4D预测老年ADHF患者短期预后不良的曲线下面积分别为0.787、0.772、0.887,NRG-1+sSema4D预测老年ADHF患者短期预后不良的曲线下面积大于NRG-1、sSema4D单独预测(P均<0.05)。结论老年ADHF患者血清NRG-1水平降低,sSema4D水平升高,二者均为短期预后不良独立影响因素,并可作为老年ADHF患者短期预后不良预测指标。Objective To investigate the relationships between serum neuregulin-1(NRG-1)and soluble signalin 4D(sSema4D)and the short-term prognosis of elderly patients with acute decompensated heart failure(ADHF).Methods Totally 225 elderly patients with ADHF were selected as the ADHF group,74 elderly patients with CHF classified by New York Heart Association(NYHA)I-II as the CHF group,and 78 healthy persons as the control group.Serum NRG-1 and sSema4D were detected by ELISA.The correlations between serum NRG-1 and sSema4D levels and left ventricular ejection fraction(LVEF)and N-terminal B-type natriuretic peptide precursor(NT proBNP)in elderly patients with ADHF were analyzed.The influencing factors for short-term prognosis in elderly patients with ADHF were analyzed by multivariate Logistic regression,and the predictive value of serum NRG-1,sSema4D level in the short-term poor prognosis of elderly patients with ADHF was analyzed by receiver operating characteristic(ROC)curve.Results Compared with the CHF and control groups,serum NRG-1 level decreased and sSema4D level increased in the ADHF group(both P<0.05);compared with the control group,serum NRG-1 level decreased and sSema4D levels increased in the CHF group(both P<0.05).Serum NRG-1 level in the elderly ADHF patients was positively correlated with LVEF and negatively correlated with NT-proBNP(r=0.602,-0.588,both P<0.001);sSema4D level was negatively correlated with LVEF and was positively correlated with NT-proBNP(r=-0.587,0.614,all P<0.001).NYHA class IV(OR=1.019,95%CI:1.002 to 1.036),NT-proBNP(OR=1.174,95%CI:1.024 to 1.347),and sSema4D(OR=1.163,95%CI:1.037 to 1.305)were independent risk factors for poor short-term prognosis in elderly patients with ADHF,and LVEF(OR=0.795,95%CI:1.024 to 1.347)and NRG-1(OR=0.813,95%CI:0.733 to 0.903)were independent protective factors(both P<0.05).The area under the curve of NRG-1,sSema4D,and NRG-1+sSema4D in predicting poor short-term prognosis of elderly ADHF patients was 0.787,0.772,and 0.887,respectively;the area under the curve o

关 键 词：急性失代偿性心力衰竭 神经调节蛋白1 可溶性信号素4D 老年人 预后 

分 类 号：R541.6[医药卫生—心血管疾病]