血浆大内皮素-1作为急性失代偿性心力衰竭患者不良结局预测因子的临床研究  

Clinical study of plasma big endothelin-1 as a predictor of adverse outcomes in patients with acute decompensated heart failure

作　　者：王建平 符大鹏 何邦立 WANG Jianping;FU Dapeng;HE Bangli(Department of Cardiovascular Medicine,Wenchang People′s Hospital,Wenchang,Hainan 571300,China;Department of Emergency,Haikou Fourth People′s Hospital,Haikou,Hainan 571100,China)

机构地区：[1]文昌市人民医院心血管内科,海南文昌571300 [2]海口市第四人民医院急诊科,海南海口571100

出　　处：《国际检验医学杂志》2023年第12期1490-1495,1501,共7页International Journal of Laboratory Medicine

基　　金：海南省自然科学基金面上项目(818MS132)。

摘　　要：目的 探讨血浆大内皮素-1(Big ET-1)作为急性失代偿性心力衰竭(ADHF)患者不良结局预测因子的可行性。方法 回顾性分析2012—2020年文昌市人民医院的787例ADHF患者的临床资料、血液标本。采用酶联免疫吸附试验检测血浆Big ET-1水平,采用Spearman相关进行相关性分析。随访患者出院后复合终点事件(心源性死亡、因心力衰竭再入院、左心室辅助装置植入及心脏移植)的发生情况,采用单因素及多因素Cox回归分析ADHF患者不良结局的影响因素。绘制Kaplan-Meier生存曲线,分析ADHF患者无复合终点事件发生的生存率。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),分析血浆Big ET-1、氨基末端脑钠肽前体(NT-proBNP)对ADHF患者不良结局的预测价值。结果 血浆Big ET-1水平与糖化血红蛋白、尿酸、肌酐、NT-proBNP均呈正相关(P<0.05)。Kaplan-Meier生存曲线结果显示,血浆Big ET-1水平>0.54 pmol/L的ADHF患者随访期间达到复合终点及心源性死亡的发生率更高(χ^(2)=11.035、5.596,P<0.05)。单因素及多因素Cox回归分析结果显示,血浆Big ET-1水平>0.54 pmol/L是ADHF患者不良结局的独立危险因素(P<0.05)。ROC曲线结果显示,NT-proBNP联合血浆Big ET-1水平预测ADHF患者不良结局的(AUC为0.902)效能较二者单独预测更佳(P<0.001)。结论 血浆Big ET-1水平升高与ADHF患者不良结局有关。Objective To investigate the feasibility of plasma big endothelin-1(Big ET-1)as a predictor of adverse outcomes in patients with acute decompensated heart failure(ADHF).Methods The clinical data and blood samples of 787 patients with ADHF in Wenchang People′s Hospital from 2012 to 2020 were retrospectively analyzed.The plasma level of Big ET-1 was measured by enzyme-linked immunosorbent assay,and the correlation was analyzed by Spearman correlation analysis.The composite end-point(cardiac death,readmission due to heart failure,left ventricular assist device implantation and heart transplantation)was followed up after discharge.Univariate and multivariate Cox regression analysis were used to analyze the influencing factors of adverse outcomes in ADHF patients.Kaplan-Meier survival curve was used to analyze the composite end-point event-free survival rate of ADHF patients.The receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculated to analyze the predictive value of plasma Big ET-1 and N-terminal pro-brain natriuretic peptide(NT-proBNP)for the adverse outcomes of ADHF patients.Results The plasma level of Big ET-1 was positively correlated with glycosylated hemoglobin,uric acid,creatinine and NT-proBNP(P<0.05).Kaplan-Meier survival curve showed that ADHF patients with plasma Big ET-1 level>0.54 pmol/L had higher incidence of composite end-point and cardiac death(χ^(2)=11.035,5.596,P<0.05).Univariate and multivariate Cox regression analysis showed that plasma Big ET-1 level>0.54 pmol/L was an independent risk factor for adverse outcomes in ADHF patients(P<0.05).The ROC curve showed that NT-proBNP combined with plasma Big ET-1 level(AUC=0.902)was better than the two alone in predicting adverse outcomes in ADHF patients(P<0.001).Conclusion Increased plasma Big ET-1 level is associated with adverse outcomes in ADHF patients.

关 键 词：大内皮素-1 急性失代偿心力衰竭 不良结局 氨基末端脑钠肽前体 

分 类 号：R541.6[医药卫生—心血管疾病]