血清标志物与老年心肌病患者心功能分级及预后的相关性分析  

Correlation of serum markers with cardiac function grade and prognosis in elderly patients with cardiomyopathy

作　　者：高田 王玲[1] 王丹[1] 王淦楠[3] 洪梅[4] 朱林 章衍达 张劲松[3] Gao Tian;Wang Ling;Wang Dan;Wang Gannan;Hong Mei;Zhu Lin;Zhang Yanda;Zhang Jinsong(Department of Critical Care Medicine,the Fourth Affiliated Hospital of Nanjing Medical University,Nanjing 211899,Jiangsu Province,China)

机构地区：[1]南京医科大学第四附属医院重症医学科,211899 [2]南京医科大学第四附属医院心血管内科,211899 [3]南京医科大学第一附属医院急诊中心 [4]南京医科大学第二附属医院心血管内科

出　　处：《中华老年心脑血管病杂志》2022年第8期824-828,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：江苏省卫生和计划生育委员会医学科研课题(H201611)。

摘　　要：目的探究血清同型半胱氨酸(Hcy)、总胆红素(TBIL)、胱抑素C(Cys C)3种血清标志物与老年扩张型心肌病(DCM)患者心脏功能的相关性及对预后的预测价值。方法以2017年1月~2019年12月在南京医科大学第四附属医院就诊的200例DCM患者为研究对象,根据心功能分级(NYHA)标准分为心功能Ⅱ级组(66例)、心功能Ⅲ级组(80例)、心功能Ⅳ级组(54例)。收集一般资料,对所有患者进行超声心动图检测,测量并计算左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)、LVEF,检测血清Hcy、Cys C、TBIL,采用Pearson或Spearman进行相关性分析。进行2年随访,采用单因素和多因素logistic回归分析确定预后的独立风险因素,采用ROC曲线图判断独立危险因素的预测价值。结果3组的LAD、LVEDD、LVEDV、LVEF、Hcy、TBIL、Cys C比较差异有统计学意义(P<0.05),随着心功能分级升高,LAD、LVEDD、LVEDV、Hcy、TBIL、Cys C显著升高,LVEF显著下降,差异有统计学意义(P<0.05)。血清Hcy、TBIL、Cys C与LAD、LVEDD、LVEDV、心功能分级呈正相关(P<0.01),与LVEF呈负相关(P<0.05,P<0.01)。多因素logistic回归分析表明,LVEDD、Hcy、TBIL、Cys C是DCM患者死亡的独立风险因素(P<0.05);Hcy、TBIL、Cys C、LVEDD的ROC曲线下面积分别为0.724(95%CI:0.653~0.794)、0.754(95%CI:0.685~0.823)、0.824(95%CI:0.759~0.888)、0.678(95%CI:0.603~0.753)。结论血清Hcy、Cys C、TBIL与DCM患者心功能存在显著相关性,是不良预后的独立危险因素,对DCM患者的预后具有预测价值。Objective To explore the correlations of serum homocysteine(Hcy),total bilirubin(TBIL)and Cystatin C(Cys C)levels with cardiac function in elderly patients with dilated cardiomyopathy(DCM)and their prognostic values.Methods A total of 200 DCM patients admitted in our Fourth Affiliated Hospital from January 2017 to December 2019 were enrolled in this study.According to the results of New York Heart Association(NYHA)Functional Classification,they were divided into NYHA ClassⅡ(n=66),NYHA ClassⅢ(n=80)and ClassⅣ(n=54).General data were collected,and all patients were tested by echocardiography for left atrial diameter(LAD),left ventricular end diastolic diameter(LVEDD),left ventricular end diastolic volume(LVEDV),left ventricular ejection fraction(LVEF).Serum levels of Hcy,Cys C and TBIL were detected.Pearson or Spearman correlation analysis was used for correlation analyses.All patients were followed up for 2 years.Univariate and multivariate logistic regression analyses were applied to explore the independent risk factors for prognosis,and receiver operating characteristic(ROC)curve was drawn to determine the predictive values of the factors.Results There were significant differences in LAD,LVEDD,LVEDV,LVEF and serum Hcy,TBIL and Cys C levels among the 3 groups(P<0.05).With the elevation of NYHA class,LAD,LVEDD,LVEDV,LVEF and serum Hcy,TBIL and Cys C levels were increased significantly,while LVEF was decreased(P<0.05).Serum Hcy,TBIL and Cys C levels were positively correlated with LAD,LVEDD,LVEDV and NYHA class(P<0.01),and negatively correlated with LVEF(P<0.05,P<0.01).Multivariate regression analysis showed that LVEDD and Hcy,TBIL and Cys C levels were independent risk factors for death in DCM patients(P<0.05).The areas under the ROC curve of Hcy,TBIL,Cys C and LVEDD were 0.724(95%CI:0.653-0.794),0.754(95%CI:0.685-0.823),0.824(95%CI:0.759-0.888)and 0.678(95%CI:0.603-0.753),respectively.Conclusion Serum Hcy,Cys C and TBIL levels are significantly correlated with cardiac function in DCM patients.They are indepe

关 键 词：心肌疾病 心肌病 扩张型 超声心动描记术 高半胱氨酸 胆红素 半胱氨酸蛋白酶抑制物C 细胞外基质 

分 类 号：R542.2[医药卫生—心血管疾病]