重症心力衰竭患者血清sTWEAK、CTGF水平与左心室重构和预后的关系  

Relationship between serum sTWEAK and CTGF levels and left ventricular remodeling and prognosis in patients with severe heart failure

作　　者：李月喜 秦俊雅 Li Yuexi;Qin Junya(Department of critical care medicine,Huaihe Hospital of Henan University,Kaifeng,Henan 475000,China;不详)

机构地区：[1]河南大学淮河医院重症医学科,开封475000 [2]河南大学淮河医院健康管理科,开封475000

出　　处：《中国循证心血管医学杂志》2023年第7期808-812,817,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190544)。

摘　　要：目的探讨重症心力衰竭(SHF)患者血清可溶性肿瘤坏死因子样细胞凋亡弱诱导因子(sTWEAK)、结缔组织生长因子(CTGF)水平与左心室重构(LVR)和预后的关系。方法选取2019年1月至2022年1月于河南大学淮河医院收治的147例SHF患者为SHF组,根据预后情况又分为预后不良亚组23例和预后良好亚组124例,另选取同期47例体检健康者为对照组,采用酶联免疫吸附法检测血清sTWEAK、CTGF水平。分析血清sTWEAK、CTGF水平与SHF患者LVR和预后的关系。结果SHF组血清sTWEAK、CTGF水平高于对照组(P<0.05)。SHF患者血清sTWEAK、CTGF水平与左心室舒张末期内径、舒张期末室间隔厚度、左室后壁厚度、左心室质量指数(LVMI)呈正相关(r/rs=0.557、0.542、0.629、0.687和0.559、0.543、0.582、0.647,P<0.001)。多因素Logistic回归分析显示,NYHA分级Ⅳ级和N末端脑钠肽前体、LVMI、TWEAK、CTGF升高为SHF患者预后不良的独立危险因素[OR(95%CI)为2.994(1.339~6.690)、1.003(1.001~1.004)、1.060(1.004~1.120)、1.016(1.001~1.031)、1.011(1.002~1.019),P<0.05]。ROC曲线分析显示,血清sTWEAK、CTGF水平单独与联合预测SHF患者预后不良的曲线下面积分别为0.792、0.797、0.874,灵敏度分别为78.26%、95.65%、91.30%,特异度分别为70.16%、52.42%、70.16%。血清sTWEAK、CTGF水平联合预测SHF患者预后不良的曲线下面积大于sTWEAK、CTGF单独预测(P<0.05)。结论SHF患者血清sTWEAK、CTGF水平升高与LVR和预后不良密切相关,可作为SHF患者预后不良的辅助预测指标。Objective This study aims to investigate the relationship between serum levels of soluble tumor necrosis factor-like apoptosis weak inducing factor(sTWEAK)and connective tissue growth factor(CTGF)with left ventricular remodeling(LVR)and prognosis in patients with severe heart failure(SHF).Methods A total of 147 SHF patients admitted to Huaihe Hospital of Henan University between January 2019 and January 2022 were included in the SHF group.Based on their prognosis,they were further divided into a poor prognosis subgroup(23 cases)and a good prognosis subgroup(124 cases).Additionally,47 healthy individuals who underwent physical examinations during the same period were selected as the control group.Serum levels of sTWEAK and CTGF were measured using an enzyme-linked immunosorbent assay(ELISA).The relationship between serum sTWEAK and CTGF levels and LVR as well as prognosis in SHF patients was analyzed.Results The SHF group exhibited significantly higher serum levels of sTWEAK and CTGF compared to the control group(P<0.05).Serum levels of sTWEAK and CTGF in SHF patients showed a positive correlation with left ventricular end-diastolic internal diameter,end-diastolic septal thickness,left ventricular posterior wall thickness,and left ventricular mass index(LVMI)(r/rs=0.557,0.542,0.629,0.687,and 0.559,0.543,0.582,0.647,all P<0.001).Multi-factor logistic regression analysis revealed that NYHA class IV,elevated N-terminal brain natriuretic peptide precursors,LVMI,TWEAK,and CTGF were independent risk factors for poor prognosis in SHF patients[OR(95%CI)=2.994(1.339~6.690),1.003(1.001~1.004),1.060(1.004~1.120),1.016(1.001~1.031),1.011(1.002~1.019)].ROC curve analysis demonstrated that the area under the curve for serum sTWEAK and CTGF levels alone and in combination in predicting poor prognosis in SHF patients were 0.792,0.797,and 0.874,respectively.The corresponding sensitivities were 78.26%,95.65%,and 91.30%,while the specificities were 70.16%,52.42%,and 70.16%,respectively.The area under the curve of the combined serum

关 键 词：重症心力衰竭 左心室重构 可溶性肿瘤坏死因子样细胞凋亡弱诱导因子 结缔组织生长因子 

分 类 号：R541.61[医药卫生—心血管疾病]