外周血胆碱酯酶水平与急性心力衰竭患者超声心动图参数及预后的相关性  

Correlation of peripheral blood cholinesterase levels with echocardiographic parameters and prognosis in patients with acute heart failure

作　　者：杨珊珊 潘宇翔 王军[1] 王政[1] YANG Shan-shan;PAN Yu-xiang;WANG Jun;WANG Zheng(The Second Department of Cardiovascular Internal Medicine,the First Affiliated Hospital of Hainan Medical College,Haikou 570000,China;Zone,Department of Critical Care Medicine,the Second Affiliated Hospital of Hainan Medical College Haikou 570311,China)

机构地区：[1]海南医学院第一附属医院心血管内二科,海南省海口市570000 [2]海南医学院第二附属医院重症医学科一区

出　　处：《中国心血管病研究》2023年第3期246-251,共6页Chinese Journal of Cardiovascular Research

基　　金：海南省卫生健康行业科研项目(20A200179)。

摘　　要：目的探讨外周血胆碱酯酶(CHE)水平与急性心力衰竭(AHF)患者超声心动图参数及预后的相关性。方法纳入2018年9月至2021年5月我院收治的AHF患者306例,收集患者临床实验室资料,采用丁酰硫代胆碱法测定外周血CHE水平,采用超声心动图检查患者左心室舒张末期内径、左心室收缩末期内径、左心室射血分数、左心房内径、下腔静脉、室间隔厚度。随访1年,记录患者出现心力衰竭再入院或全因死亡情况。根据患者随访情况分为预后不良组和预后良好组,对比两组临床资料,采用多因素logistic回归分析影响患者预后不良的相关因素;采用Pearson线性回归方程分析CHE与超声心动图参数的相关性;绘制受试者工作特征曲线,分析CHE在早期评估AHF预后不良的应用价值。结果随访1年,失访6例,共有45例发生心力衰竭再入院或全因死亡。据此分组后比较显示,预后不良组年龄、心房颤动(房颤)比例、脑钠肽(BNP)水平、左室舒张末期内径(LVED)、室间隔厚度(IVS)、下腔静脉内径(IVC)高于预后良好组,血胆碱酯酶(CHE)、左心室射血分数(LVEF)水平低于预后良好组,差异具有统计学意义(P<0.05);多因素logistic回归分析显示,CHE(OR=0.998)是AHF预后不良的独立保护因素,年龄(OR=1.106)、合并房颤(OR=3.093)、BNP(OR=1.003)是AHF预后不良的独立危险因素(P<0.05);Pearson线性相关性分析显示,CHE与LVED、IVC、IVS、BNP呈负相关(r=-0.531、-0.425、-0.437,-0.192,P均<0.05);RCS曲线分析显示,CHE水平与急性心衰患者出院1年内不良事件发生风险呈显著线性关系(非线性=0.65,P=0.732);ROC曲线分析显示,CHE在评估急性心衰患者出院1年内不良事件风险AUC为0.829,敏感度为86.67%,特异度为68.24%,截点值为4302.49 U/L。结论低血清胆碱酯酶水平与AHF患者超声心动图的充血征象以及不良预后具有显著相关性。Objective To investigate the correlation between peripheral blood cholinesterase(CHE)levels and echocardiographic parameters and prognosis in patients with acute heart failure(AHF).Methods The clinical data of 306 patients with AHF admitted to our hospital from September 2018 to May 2021 were collected and the clinical laboratory data were recorted.Peripheral blood CHE levels were measured by the butyryl thiocholine method and the patients’left ventricular end-diastolic internal diameter,left ventricular end-systolic internal diameter,left ventricular ejection fraction,left atrial internal diameter,inferior vena cava and ventricular septal thickness were examined by echocardiography.The patients were followed up for 1 year and the readmission or all cause death were recorded when they developed heart failure.The patients were divided into the poor prognosis and good prognosis groups according to their follow-up.The clinical data of the two groups were compared.The correlation between CHE and echocardiographic parameters was analyzed using multi-factor logistic regression;the correlation between CHE and echocardiographic parameters was analyzed using Pearson linear regression equation;the working characteristic curves of subjects were plotted to analyze the application value of CHE in the early assessment of poor prognosis.Results During 1 year of follow-up,6 cases were lost,and a total of 45 cases had heart failure readmission or all-cause death.The comparison between 2 groups showed that age,proportion of atrial fibrillation,BNP level,LVED,IVS,and IVC were higher in the poor prognosis group than in the good prognosis group,and the levels of CHE and LVEF were lower than in the good prognosis group,with a statistically significant differences(P<0.05).Multi-factor logistic regression analysis showed that CHE(OR=0.998)was a independent protective factor for the poor prognosis in AHF;age(OR=1.106),combined atrial fibrillation(OR=3.093)and BNP(OR=1.003)were the independent risk factors for the poor prognosis in AHF(

关 键 词：胆碱酯酶 急性心力衰竭 超声心动图 预后 心功能 

分 类 号：R514.6[医药卫生—内科学]