血清Nesfatin-1、S100A4、ANGPTL4与老年慢性心力衰竭合并心房颤动患者心脏超声指标和预后的关系研究  

Relationship between serum Nesfatin-1,S100A4,ANGPTL4 and cardiac ultrasound indexes and prognosis in elderly patients with chronic heart failure combined with atrial fibrillation

作　　者：周姣珍 张国梁 杨娜 董卫青 武金娥 ZHOU Jiaozhen;ZHANG Guoliang;YANG Na;DONG Weiqing;WU Jin′e(Department of Geriatrics,Yuncheng Central Hospital,Yuncheng,Shanxi 044000,China;First Department of Internal Medicine-Cardiovascular,Yuncheng Central Hospital,Yuncheng,Shanxi 044000,China)

机构地区：[1]运城市中心医院老年病科,山西运城044000 [2]运城市中心医院心血管内一科,山西运城044000

出　　处：《国际检验医学杂志》2023年第7期787-792,共6页International Journal of Laboratory Medicine

基　　金：山西省科技攻关项目(20200113015-8)。

摘　　要：目的研究血清摄食抑制因子1(Nesfatin-1)、S100钙结合蛋白A4(S100A4)、血管生成素样蛋白4(ANGPTL4)与老年慢性心力衰竭(CHF)合并心房颤动(AF)患者心脏超声指标和预后的关系。方法选取2020—2021年该院收治的285例老年CHF患者,根据是否合并AF分为合并AF组(91例)和未合并AF组(194例),比较两组血清Nesfatin-1、S100A4、ANGPTL4水平和心脏超声指标。Pearson相关分析老年CHF合并AF患者血清Nesfatin-1、S100A4、ANGPTL4与心脏超声指标相关性;多因素Logistic回归模型分析患者预后不良的危险因素,受试者工作特征(ROC)曲线分析相关指标对患者预后不良发生风险的预测价值。结果合并AF组血清Nesfatin-1、ANGPTL4水平低于未合并AF组,S100A4水平高于未合并AF组(P<0.05)。合并AF组左心房内径(LAD)、左心室舒张末内径(LVEDD)高于未合并AF组,左心室射血分数(LVEF)低于未合并AF组(P<0.05)。血清Nesfatin-1、ANGPTL4水平与LAD、LVEDD呈负相关,与LVEF呈正相关(P<0.05);血清S100A4水平与LAD、LVEDD呈正相关,与LVEF呈负相关(P<0.05)。预后不良组与预后良好组的性别、心功能分级、高血压、总胆红素、直接胆红素、NT-proBNP、Nesfatin-1、S100A4、ANGPTL4、血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)治疗占比差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,有高血压病史、血清S100A4水平上升为患者预后不良的独立危险因素,Nesfatin-1、ANGPTL4水平升高及使用ACEI/ARB治疗为其独立保护因素(P<0.05)。ROC曲线显示,Nesfatin-1、S100A4、ANGPTL4三者联合对预后不良发生风险的预测价值高于单独检测及两项联合检测。结论血清Nesfatin-1、S100A4、ANGPTL4水平与老年CHF合并AF患者心功能密切相关,低水平Nesfatin-1、ANGPTL4与高水平S100A4为患者预后不良的独立危险因素,检测血清Nesfatin-1、S100A4、ANGPTL4有助于预测患者预后不良的发生风险。Objective To study the relationship between serum Nesfatin-1,S100 calcium binding protein A4(S100A4),angiopoietin like protein 4(ANGPTL4)and cardiac ultrasound indexes and prognosis in elderly patients with chronic heart failure(CHF)combined with atrial fibrillation(AF).Methods A total of 285 elderly patients with CHF in Yuncheng Central Hospital from 2020 to 2021 were selected.According to whether they were combined with AF,they were divided into combined AF group(91 cases)and non combined AF group(194 cases).The levels of serum Nesfatin-1,S100A4,ANGPTL4 and cardiac ultrasound indexes were compared between the two groups.Pearson method was used to analyze the correlation between serum Nesfatin-1,S100A4,ANGPTL4 and cardiac ultrasound indexes in elderly patients with CHF combined with AF.Multivariate Logistic regression model was used to analyze the risk factors of poor prognosis of patients,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum for the occurrence risk of poor prognosis of patients.Results The levels of serum Nesfatin-1 and ANGPTL4 in the combined AF group were lower than those in the non combined AF group,and the level of S100A4 was higher than that in the non combined AF group(P<0.05).The left atrial diameter(LAD)and left ventricular end diastolic diameter(LVEDD)in the combined AF group were higher than those in the non combined AF group,and the left ventricular ejection fraction(LVEF)was lower than that in the non combined AF group(P<0.05).The level of serum S100A4 was negatively correlated with LAD and LVEDD,and positivelycorrelated with LVEF(P<0.05).There were significant differences in gender,cardiac function grade,hypertension,total bilirubin,direct bilirubin,NT-proBNP,Nesfatin-1,S100A4,ANGPTL4,angiotensin converting enzyme inhibitor(ACEI)/angiotensinⅡreceptor antagonist(ARB)treatment between the poor prognosis group and the good prognosis group(P<0.05).Multivariate Logistic regression analysis showed that the history of hypertension and the rise

关 键 词：慢性心力衰竭 心房颤动 摄食抑制因子1 S100钙结合蛋白A4 血管生成素样蛋白4 

分 类 号：R446.1[医药卫生—诊断学]