运动前后活性氧代谢衍生物对老年心力衰竭患者预后的预测价值  

The Predictive Value of Reactive Oxygen Species Metabolic Derivative Before and After Exercise on the Prognosis of Elderly Patients with Heart Failure

作　　者：李帅 韩雪[1] 马文静 黄国虹[1] Li Shuai;Han Xue;Ma Wenjing;Huang Guohong(Clinical Laboratory Center,Xinjiang Uygur Autonomous Region People's Hospital,Urumqi 830001;Department of Laboratory,Urumqi Traditional Chinese Medicine Hospital,Urumqi 830002)

机构地区：[1]新疆维吾尔自治区人民医院临床检验中心,乌鲁木齐830001 [2]乌鲁木齐市中医医院检验科,乌鲁木齐830002

出　　处：《国际老年医学杂志》2024年第1期53-58,共6页International Journal of Geriatrics

基　　金：新疆维吾尔自治区自然科学基金(2020D01C302)。

摘　　要：目的探讨心肺运动试验前后活性氧代谢衍生物(D-ROM)对老年心力衰竭(简称心衰)患者预后的评估价值。方法选取2020年7月—2021年9月新疆维吾尔自治区人民医院收治的300例急性心衰老年患者进行前瞻性研究,随访1年,根据患者预后情况分为预后不良组(45例)和预后良好组(255例)。收集患者的临床实验室资料,在患者病情稳定后进行心肺运动试验,检测心肺运动试验前和试验后的血清D-ROM、超氧化物歧化酶(SOD)、丙二醛(MDA)水平;采用超声心动图检测患者左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)、左房内径(LAD)、下腔静脉内径(IVCD)、室间隔厚度(IVST)。采用多因素logistic回归模型分析影响患者预后的相关因素,应用RMS软件包绘制限制性立方样条(RCS)分析D-ROM水平与老年心衰患者预后不良风险的关系。结果预后不良组年龄大于预后良好组,合并房颤比例高于预后良好组,LVEDD、IVCD、IVST长于预后良好组,LVEF小于预后良好组,运动后D-ROM及△D-ROM高于预后良好组,差异均有统计学意义(P<0.05);运动前后两组SOD、MDA水平的组间比较,差异均无统计学意义(P>0.05)。多因素logistic回归模型分析显示,LVEF、无房颤是老年心衰患者预后不良的独立保护因素(P<0.05),年龄、△D-ROM是老年心衰患者预后不良的独立危险因素(P<0.05)。RCS曲线分析显示,△D-ROM与急性心衰老年患者出院1年内不良事件发生风险呈显著非线性关系(P<0.001)。结论运动前后的D-ROM变化与老年心衰患者预后不良高度相关。Objective To investigate the prognostic value of reactive oxygen species metabolic derivatives(D-ROM)in elderly patients with heart failure before and after cardiopulmonary exercise testing.Methods A prospective study was conducted on 300 elderly patients with acute heart failure admitted to Xinjiang Uygur Autonomous Region People's Hospital from July 2020 to September 2021.The patients were followed up for 1 year and divided into a poor prognosis group(45 cases)and a good prognosis group(255 cases)according to their prognosis.The clinical laboratory data of the patients were collected,and cardiopulmonary exercise tests were performed after the patients were stable to detect the serum D-ROM,superoxide dismutase(SOD),and malondialdehyde(MDA)levels before and after the test;left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular ejection fraction(LVEF),left atrial diameter(LAD),inferior vena cava diameter(IVCD),and interventricular septum thickness(IVST)were measured by echocardiography.Multivariate logistic regression model was used to analyze the related factors affecting the prognosis of patients,and restricte.Results The poor prognosis group was older than the good prognosis group,the proportion of atrial fibrillation was higher than the good prognosis group,LVEDD,IVCD,IVST were longer than the good prognosis group,LVEF was lower than the good prognosis group,D-ROM and D-ROM after exercise were higher than the good prognosis group,the differences were statistically significant(P<0.05);there were no significant differences in SOD and MDA levels between the two groups before and after exercise(P>0.05).Multivariate logistic regression model analysis showed that LVEF,without atrial fibrillation were the independent protective factor for poor prognosis in elderly patients with heart failure(P<0.05),and age,D-ROM were independent risk factors for poor prognosis in elderly patients with heart failure(P<0.05).RCS curve analysis showed that there was a significant no

关 键 词：心力衰竭 心肺运动试验 活性氧代谢衍生物 预后 

分 类 号：R541.6[医药卫生—心血管疾病]