心型脂肪酸结合蛋白的相关影响因素及其对心力衰竭的预后价值  

Risk factors and prognostic value of heart-type fatty acid binding protein in patients with heart failure

作　　者：陈雨意 田鹏超 邹长虹[1] 冯佳禹 黄燕[1] 周琼[1] 翟玫[1] 庄晓峰[1] 吴易航 黄博平 关敬元 王静[1] 李心晴 赵雪梅[1] 许天昱 张宇辉[1] 张健[1] Chen Yuyi;Tian Pengchao;Zou Changhong;Feng Jiayu;Huang Yan;Zhou Qiong;Zhai Mei;Zhuang Xiaofeng;Wu Yihang;Huang Boping;Guan Jingyuan;Wang Jing;Li Xinqing;Zhao Xuemei;Xu Tianyu;Zhang Yuhui;Zhang Jian(Heart Failure Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心力衰竭中心,北京100037

出　　处：《中华检验医学杂志》2022年第9期968-976,共9页Chinese Journal of Laboratory Medicine

基　　金：国家重点研发计划项目(2017YFC1308300,2017YFC1308301,2017YFC1308305);国家自然科学基金(81873472);2019年医疗服务与保障能力提升项目。

摘　　要：目的探讨心型脂肪酸结合蛋白(H-FABP)的相关影响因素及其对心力衰竭(心衰)的预后价值。方法纳入2015年7月至2017年7月在中国医学科学院阜外医院心衰重症监护病房住院的心衰患者877例进行回顾性研究,采用荧光免疫层析法检测患者基线血清中的H-FABP浓度。根据H-FABP水平三分位数值分为低H-FABP组(H-FABP≤4.04 ng/ml,n=292)、中H-FABP组(H-FABP 4.04~7.02 ng/ml,n=292)和高H-FABP组(H-FABP≥7.02 ng/ml,n=293),比较3组患者的一般临床资料;此外,根据患者心衰是否为冠心病所引起分为缺血性心衰和非缺血性心衰亚组。采用多元线性回归分析与H-FABP独立相关的影响因素。主要临床终点事件为全因死亡或心脏移植,采用多因素Cox回归分析、受试者工作特征(ROC)曲线、多因素Cox回归模型风险预测检验及Kaplan-Meier生存曲线评估基线H-FABP对心衰的预后价值。结果多元线性回归分析结果显示,年龄、冠心病、丙氨酸氨基转移酶、尿酸及N末端B型利钠肽原(NT-proBNP)与H-FABP呈正相关(β=0.012、0.238、0.001、0.345、0.063,P均<0.05),女性、血红蛋白、白蛋白、血钠及估算肾小球滤过率(eGFR)与H-FABP呈负相关(β=-0.184、-0.006、-0.016、-0.034、-0.006,P均<0.05)。共有119例(13.6%)患者出现失访,在随访931(412~1185)d时,246例(32.5%)患者发生了全因死亡或心脏移植。多因素Cox回归分析结果显示,基线H-FABP(log2H-FABP)是心衰患者发生全因死亡或心脏移植的独立预测因子(HR=1.39,P<0.001)。ROC曲线分析结果显示,基线H-FABP对心衰患者3个月、1年及2年发生全因死亡或心脏移植均具有较好的预测价值(ROC曲线下面积分别为0.69、0.69及0.71),对应的基线H-FABP最佳截断值分别为5.85、6.54和6.54 ng/ml。多因素Cox回归模型风险预测检验结果显示,在基础模型和基线NT-proBNP基础上,联用基线H-FABP可为心衰预后评估提供额外的预测价值(P<0.001)。H-FABP分别以6.54 ng/ml(RObjective To investigate the prognostic value and related factors of heart-type fatty acid binding protein(H-FABP)in patients with heart failure.Methods A total of 877 consecutive patients who were admitted to heart failure care unit of Fuwai hospital and diagnosed as heart failure from July 2015 to July 2017 were enrolled in this study.Baseline serum H-FABP concentration was measured by fluorescence lateral flow immunoassay.According to serum H-FABP levels,patients were divided into three groups:low H-FABP group(H-FABP≤4.04 ng/ml,n=292),middle H-FABP group(H-FABP 4.04-7.02 ng/ml,n=292)and high H-FABP group(H-FABP≥7.02 ng/ml,n=293).The general clinical characteristics were collected and compared among the three groups.According to whether heart failure was caused by coronary artery disease or not,patients with heart failure were divided into ischemic heart failure and non-ischemic heart failure.Multivariate linear regression analysis was performed to explore the independent risk factors of H-FABP.The primary endpoint events were the composite of all-cause death or heart transplantation.Multivariate Cox regression analyses,receiver operating characteristic(ROC)curves,risk prediction tests with multivariate Cox regression model and Kaplan-Meier analyses were conducted to investigate the relationship between H-FABP and the prognosis of heart failure.Results Multivariate linear regression analysis showed that age,coronary artery disease,alanine aminotransferase,uric acid and N-terminal pro-B type natriuretic peptide(NT-proBNP)were positively associated with H-FABP(β=0.012,0.238,0.001,0.345 and 0.063 respectively,all P<0.05),while female,hemoglobin,albumin,sodium,and estimated glomerular filtration rate(eGFR)were negatively associated with H-FABP(β=-0.184,-0.006,-0.016,-0.034 and-0.006 respectively,all P<0.05).One hundred and nineteen patients(13.6%)lost to follow-up,and 246 patients(32.5%)suffered from all-cause death or heart transplantation during the median follow-up duration of 931(412-1185)days.Multivariat

关 键 词：心力衰竭 心型脂肪酸结合蛋白 影响因素 预后 

分 类 号：R541.6[医药卫生—心血管疾病]