血清多种标志物联合预测慢性心力衰竭患者心室重构及预后的临床研究  

Clinical study of serum LCN2,D-dimer and NT-proBNP levels in predicting ventricular remodeling and major adverse cardiovascular events in patients with chronic heart failure

作　　者：关杨[1] 刘新民[1] 郭飞[1] 张骞[1] 李红[1] 董建增[1] GUAN Yang;LIU Xinmin;GUO Fei;ZHANG Qian;LI Hong;DONG Jianzeng(Department of Cardiology for Heart Failure Ward,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内七科心力衰竭病房,100029

出　　处：《心肺血管病杂志》2022年第4期338-343,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：心血管疾病精准医学北京实验室(PXM2020_014226_000017_00377132_FCG)。

摘　　要：目的:探究血清脂质运载蛋白2(LCN2)、D-二聚体(D-D)、N末端脑钠肽前体(NT-proBNP)水平联合预测慢性心力衰竭(CHF)患者心室重构及不良心血管事件(MACE)的临床价值。方法:选择2019年1月到2020年5月,我院收治的114例CHF患者作为CHF组,检测所有患者血清LCN2、D-D、NT-proBNP水平,收集患者一般临床资料并随访1年,分析血清LCN2、D-D、NT-proBNP水平对发生心室重构和MACE的预测价值。结果:114例患者有24例(21.1%)发生心室重构,其中心室重构组病程、LVEDV、LCN2、D-D、NT-proBNP水平高于无心室重构组,LVEF低于无心室重构组(P<0.05),多因素Logistic回归分析显示,LVEDV、LCN2、D-D、NT-proBNP是影响患者发生心室重构的高危因素(P<0.05);114例患者有18例(15.8%)发生MACE事件,其中MACE组病程、LVEDV、LCN2、D-D、NTproBNP水平及NYHA分级Ⅲ-Ⅳ级比例高于无MACE组,LVEF低于无MACE组(P<0.05),多因素Logistic回归分析显示,病程、LVEF、LCN2、D-D、NT-proBNP、NYHA分级是影响患者发生MACE的高危因素(P<0.05);建立ROC曲线,血清LCN2、D-D、NT-proBNP水平联合诊断CHF患者发生心室重构的敏感度、特异度、AUC分别为87.5%、96.7%、0.969,诊断CHF患者发生MACE的敏感度、特异度、AUC分别为88.9%、94.8%、0.951,均高于单个指标的诊断效能(P<0.05)。结论:血清LCN2、D-D、NT-proBNP水平在CHF患者中表达水平升高,且与心力衰竭严重有关,三者联合对诊断患者发生心室重构及MACE具有较好的临床应用价值。Objective:To explore the clinical value of serum lipocalin 2(LCN2),D-dimer(D-D),and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels to predict ventricular remodeling and major adverse cardiovascular events(MACE)in patients with chronic heart failure(CHF).Methods:One hundred and fourteen CHF patients admitted to our hospital from January 2018 to May 2019 were selected as the CHF group.The serum LCN2,D-D,and NT-proBNP levels of all subjects were detected.The general clinical data was collected and patients were followed up for 1 year to analyze the predictive value of serum LCN2,D-D,and NT-proBNP levels on the occurrence of ventricular remodeling and MACE.Results:Ventricular remodeling occurred in 24 of 114 patients(21.1%),with higher disease duration,LVEDV,LCN2,D-D,and NT-proBNP levels and lower LVEF in the ventricular remodeling group than in non-ventricular remodeling group(P<0.05).Multivariate logistic regression analysis showed that LVEDV,LCN2,D-D and NT-proBNP were the factors affecting ventricular remodeling(P<0.05).MACE events occurred in 18 of 114 patients(15.8%),in which the disease duration,LVEDV,LCN2,D-D,NT-proBNP levels and the proportion of NYHA class III-IV were higher and LVEF was lower in the MACE group than in the non-MACE(P<0.05).Multivariate logistic regression analysis showed that disease course,LVEF,LCN2,D-D,NT-proBNP and NYHA grade were the factors affecting MACE(P<0.05).ROC curve was established.The sensitivity,specificity,and AUC of combined diagnosis of ventricular remodeling in CHF patients with serum LCN2,DD,and NT-proBNP levels were 87.40%,90.20%,and 0.927,respectively.The sensitivity,specificity,and AUC for diagnosing MACE of CHF patients were 82.50%,93.40%,and 0.913,respectively,which were all higher than the diagnostic performance of a single indicator(P<0.05).Conclusions:Serum LCN2,D-D,and NT-proBNP levels are elevated in CHF patients and are related to severe heart failure.The combination of the three has a good clinical application value in diagnosing patients with ventr

关 键 词：脂质运载蛋白2 D-二聚体 N末端脑钠肽前体 慢性心力衰竭 

分 类 号：R54[医药卫生—心血管疾病]