扩张型心肌病患者的血清分泌型卷曲相关蛋白4水平及其临床预后预测价值分析  

Serum Level and Clinical Implication of Secreted Frizzled-related Protein 4 in Peripheral Blood of Patients With Dilated Cardiomyopathy

作　　者：王宇成 虞莹 石卉 虞勇 陈瑞珍 WANG Yucheng;YU Ying;SHI Hui;YU Yong;CHEN Ruizhen(Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai Institute of Cardiovascular Diseases,Shanghai 200032,China;Department of General Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Cardiology,Shanghai Geriatrics Center,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院心内科上海市心血管病研究所,上海200032 [2]复旦大学附属中山医院全科医学科,上海200032 [3]复旦大学附属中山医院上海市老年医学中心心内科,上海200032

出　　处：《中国循环杂志》2025年第1期54-62,共9页Chinese Circulation Journal

基　　金：国家自然科学基金(82070390,82370361);中山医院临床研究专项基金(2020ZSLC10)。

摘　　要：目的:分析扩张型心肌病(DCM)患者的血清分泌型卷曲相关蛋白4(SFRP4)水平及其临床预后预测价值。方法:连续入选2017年1月至2019年1月就诊于复旦大学附属中山医院心内科并确诊为DCM的患者259例为DCM组,另选取本院体检中心同时期进行健康体检,没有心力衰竭病史、超声心动图检查左心室射血分数正常且N末端B型利钠肽原(NT-proBNP)水平正常的84名体检者为对照组。采用酶联免疫吸附试验(ELISA)法检测血清SFRP4水平,分析SFRP4水平与DCM的相关性及其对DCM患者的预后预测价值。结果:与对照组相比,DCM组患者血清SFRP4水平明显升高[(28.54±10.25)ng/ml vs.(52.70±19.74)ng/ml,P<0.05]。随机将具有预后数据的234例DCM患者按2∶1的比例分为训练集(n=156)与验证集(n=78)。训练集进行多因素Logistic回归分析显示,血清SFRP4水平与全因死亡独立相关(OR=1.06,95%CI:1.03~1.10,P<0.001)。进一步评估模型预测效果,训练集与验证集受试者工作特征(ROC)曲线(曲线下面积均>0.8)、校准曲线和决策曲线分析均表明包含血清SFRP4水平用于构建预测模型对DCM患者的全因死亡预测具有较好的价值。Kaplan-Meier生存曲线分析显示,中位随访33.5(11.0,49.0)个月,血清SFRP4≥75百分位水平DCM患者的无事件累积生存率显著低于血清SFRP4<75百分位水平DCM患者(16.57%vs.28.81%,P=0.02)。结论:DCM患者血清SFRP4水平显著升高,SFRP4水平对于DCM的预后预测具有潜在的临床价值。Objectives:To investigate the expression and clinical prognostic implication of secreted frizzled-related protein 4(SFRP4)in the peripheral blood of patients with dilated cardiomyopathy(DCM)and its.Methods:A total of 259 consecutive patients diagnosed with DCM who were admitted to the Cardiac Center of Zhongshan Hospital,Fudan University,from January 2017 to January 2019 were selected for the DCM group.Additionally,84 individuals who underwent health examinations and echocardiography at our hospital during this period,confirmed to be free of cardiovascular diseases,were selected as the control group.Peripheral serum samples were collected from both groups,and serum SFRP4 levels were measured using enzyme-linked immunosorbent assay(ELISA).The correlation between SFRP4 levels and DCM severity,as well as its predictive value for DCM prognosis,were analyzed.Results:Compared to the control group,the serum SFRP4 levels in the DCM group were significantly elevated([28.54±10.25]ng/ml vs.[52.70±19.74]ng/ml,P<0.05).The DCM group was randomly divided into a training set and a validation set in a 2:1 ratio.Multivariate logistic regression analysis in the training set revealed that serum SFRP4 levels were independently associated with all-cause mortality in DCM patients(OR=1.06,95%CI:1.03-1.10,P<0.001).We further evaluated the model's predictive performance with the receiver operating characteristic(ROC)curves(area under curve>0.8),calibration curves,and decision curve analysis,results indicated that the predictive model containing serum SFRP4 levels showed good performance on predicting all-cause mortality in DCM patients.Kaplan-Meier survival curve analysis demonstrated that during a median follow-up of 33.5(11.0,49.0)months,DCM patients with high peripheral blood SFRP4 levels(≥75th percentile)had a significantly higher incidence of all-cause mortality compared to those with low levels(<75th percentile)(28.81%vs.16.57%,P=0.02).Conclusions:The level of SFRP4 in the peripheral blood of DCM patients is significantly elevat

关 键 词：扩张型心肌病 分泌型卷曲相关蛋白4 全因死亡 预后预测 

分 类 号：R54[医药卫生—心血管疾病]