心功能指标及免疫球蛋白对预测心脏瓣膜置换术后患者预后效能的分析  

Cardiac function,myocardial necrosis markers,and immunoglobulin predict postoperative prognostic efficacy in patients with heart valve replacement

作　　者：戚晓通 张林飞 宋媛媛 胡帅 张伟 QI Xiaotong;ZHANG Linfei;SONG Yuanyuan;HU Shuai;ZHANG Wei(Department of Cardiovascular Surgery,The first affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院心脏大血管外科,210029

出　　处：《心肺血管病杂志》2025年第3期282-287,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：江苏省卫生计生委2022年度面上科研(H2022015)。

摘　　要：目的:探讨心功能、心肌损伤标志物及免疫球蛋白对心脏瓣膜置换患者术后疗效的预测作用。方法:回顾性分析在2020年1月至2023年12月期间于南京医科大学第一附属医院行心脏瓣膜置换术的患者300例,分析患者术前、术后免疫球蛋白A(immunoglobulin A,IgA)、免疫球蛋白G(immunoglobulin G,IgG)、cTnI、CK-MB、心脏指数(cardiac index,CI)、LVEF,再经1年随访,根据预后情况,分为预后良好组(n=282)、预后不良组(n=18),比较两组IgA、IgG、cTnI、CKMB、CI、LVEF,上述指标与预后关系,经ROC曲线分析各项指标预测效能。结果:患者术后1个月的cTnI(0.3±0.1)μg/L、CK-MB(12.7±2.3)U/L低于术前,IgA(2.1±0.4)g/L、IgG(16.3±2.3)g/L、CI(2.7±0.3)L·min^(-1)·m^(-2)、LVEF(54.2±5.3)%高于术前(P<0.05)。经1年随访,患者预后不良率6.0%(18/300),预后良好的cTnI(0.3±0.1)μg/L、CK-MB(11.8±2.2)U/L低于预后不良,IgA(2.1±0.8)g/L、IgG(15.8±3.6)g/L、CI(2.2±0.3)L·min^(-1)·m^(-2)、LVEF(56.1±6.4)%高于预后不良(P<0.05);经Spearman法分析,预后情况与cTnI、CK-MB呈负相关性,与IgA、IgG、CI、LVEF呈正相关性;经ROC曲线分析,IgA、IgG、cTnI、CK-MB、CI、LVEF预测心脏瓣膜置换术预后不良的AUC分别为0.798、0.792、0.670、0.869、0.789、0.841;经COX回归模型分析,IgA、IgG、CI、LVEF会对预后产生显著的正向影响关系,cTnI、CK-MB会对预后产生显著的负向影响关系。结论:心脏瓣膜置换术患者术后cTnI、CK-MB水平下降,IgA、IgG、CI、LVEF水平上升,上述指标水平变化与预后具有一定相关性。若cTnI、CK-MB水平越低,IgA、IgG、CI、LVEF水平越高,提示预后越好,可作为预测预后重要指标,具有一定检测意义。Objective:Explore the efficacy of cardiac function(CI,LVEF),myocardial necrosis markers(cTnI,CK-MB),and immunoglobulin(IgA,IgG)to predict postoperative outcome in patients with heart valve replacement.Methods:A prospectively selected 300 patients with heart valve replacement were admitted from January 2020 to December 2023.The preoperative and postoperative IgA,IgG,cTnI,CK-MB,CI,LVEF were analyzed.One-year follow-up,according to the prognosis,they were divided into a good prognosis group(n=282)and a poor prognosis group(n=18).The immune function,cardiac function,and myocardial indexes were compared between the two groups.Prognostic relationship,the predictive performance of each index was analyzed by ROC curve.Results:The patient had lower cTnI(0.3±0.1)μg/L,CK-MB(12.7±2.3)U/L at 7 days(one month)postoperatively,and IgA(2.1±0.4)g/L,IgG(16.3±2.3)g/L,CI(2.7±0.3)L·min^(-1)·m^(-2),LVEF(54.2±5.3)%was higher than preoperatively(P<0.05).After a 1-year follow-up visit,The poor prognosis rate of patients is 6.0%(18/300),The good prognosis cTnI(0.3±0.1)μg/L,CK-CB(11.8±2.2)U/L are lower than the poor prognosis,IgA(2.1±0.8)g/L,IgG(15.8±3.6)g/L,CI(2.2±0.3)L·min^(-1)·m^(-2),LVEF(56.1±6.4)%were higher than poor prognosis(P<0.05);Analyzed by the Spearman method,Prognostic situation showed a negative correlation with cTnI,CK-MB,Positive correlation with IgA,IgG,CI,and LVEF;After the ROC curve analysis,The AUC of IgA,IgG,cTnI,CK-MB,CI,and LVEF for predicting the poor prognosis of heart valve replacement were 0.798,0.792,0.670,0.869,0.789,and 0.841,respectively;After the COX regression model analysis,IgA,IgG,CI,LVEF will have a significant positive effect on prognosis,The cTnI,CK-MB will have a significant negative effect on prognosis.Conclusions:The levels of cTnI and CK-MB decreased and the levels of IgA,IgG,CI and LVEF increased in patients after cardiac valve replacement.The changes of the above indicators have certain correlation with the prognosis.If the cTnI and CK-MB levels are lower,the IgA,IgG,CI and LVEF

关 键 词：心脏瓣膜置换术 免疫球蛋白 心功能 预后 心肌损伤标志物 

分 类 号：R54[医药卫生—心血管疾病]