ET-1、Apelin联合心电图检测对肥厚型心肌病的诊断价值及与预后的关系  

Diagnostic value of ET-1,Apelin combined with ECG for hypertrophic cardiomyopathy and their association with prognosis

作　　者：沈渝玥 孙更新[1] 王夏莉 王西辉[1] SHEN Yu-yue;SUN Geng-xin;WANG Xia-li;WANG Xi-hui(Department of Cardiology,the Second Affiliated Hospital of Xi'an Medical University,Xi'an,Shaanxi,710000,China)

机构地区：[1]西安医学院第二附属医院心内科,陕西西安710000

出　　处：《心血管康复医学杂志》2025年第2期205-211,共7页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨内皮素-1(ET-1)、脂肪细胞因子(Apelin)在肥厚型心肌病(HCM)患者中的水平及其联合心电图检测对HCM的诊断价值及与预后关系。方法:选择西安医学院第二附属医院2020年6月至2022年6月收治的150例HCM患者作为观察组,依据随访期间死亡情况将观察组分为存活组(n=64)和死亡组(n=86),另选择同期于本院进行健康体检的100名健康志愿者为对照组。对比上述各组ET-1、Apelin和心电图指标;采用受试者工作特征(ROC)曲线分析ET-1、Apelin和心电图联合检测对HCM的诊断价值;采用多因素Logistic回归分析HCM患者随访6个月死亡的影响因素,并建立列线图模型。结果:与对照组比较,观察组ET-1水平[(0.64±0.15)pmol/L比(0.39±0.07)pmol/L]、QRS波群(ΣQRS)[(23.60±3.96)mm比(14.02±1.78)mm]、Cornell电压指数(SV3+RaVL)[(2.12±0.40)mV比(1.05±0.20)mV]和V1导联的S波+V5导联的R波(SV1+RV5)[(3.88±0.73)mV比(2.24±0.34)mV]均显著升高,Apelin[(1.10±0.25)pg/ml比(1.58±0.17)pg/ml]水平显著降低(P均<0.001)。ROC分析显示,上述5个指标联合检测诊断HCM的曲线下面积(AUC)为0.933(95%CI 0.895~0.961),显著高于任一单独检测(Z=3.681~6.428,P均<0.001),且校准曲线的H-L拟合优度检验P=0.056,表示模型接受度良好,决策曲线分析(DCA)显示ET-1、Apelin联合心电图检测模型在HCM中具有较好的临床应用价值。多因素Logistic回归分析显示ET-1、ΣQRS、SV3+RaVL及SV1+RV5为HCM患者6个月内死亡的独立危险因素(OR=2.617~3.600,P均<0.001),Apelin为其独立保护因素(OR=0.271,P<0.001)。HCM患者6个月内死亡的列线图模型为:4.627+0.452×ET-1+0.536×Apelin+0.575×ΣQRS+0.541×SV3+RaVL+0.352×SV1+RV5。结论:HCM患者血清ET-1、Apelin水平均有显著改变,两者联合心电图检测对HCM具有较高诊断价值且是其6个月内死亡的独立影响因素。Objective:To investigate levels of endothelin-1(ET-1)and Apelin in patients with hypertrophic cardiomyopathy(HCM)and diagnostic value of their combination with ECG for HCM,and their association with prognosis.Methods:A total of 150 HCM patients admitted in the Second Affiliated Hospital of Xi'an Medical University between June 2020 and June 2022 were selected as observation group.According to death during follow-up,the observation group was divided into survival group(n=64)and death group(n=86),and another 100 healthy volunteers who underwent physical examination in our hospital simultaneously were selected as control group.ET-1,Apelin and ECG indexes were compared between above-mentioned groups.Diagnostic value of ET-1,Apelin and ECG combined detection for HCM was analyzed by receiver operating characteristic(ROC)curve.Multivariate Logistic regression was used to analyze influencing factors of death within 6-month follow-up in HCM patients,and nomogram model was established.Results:Compared with participants in control group,those in the observation group had significant higher ET-1[(0.64±0.15)pmol/L vs.(0.39±0.07)pmol/L],QRS wave group(ΣQRS)[(23.60±3.96)mm vs.(14.02±1.78)mm],Cornell voltage index(SV3+RaVL)[(2.12±0.40)mV vs.(1.05±0.20)mV]and S-wave on V1 lead+R-wave on V5 lead(SV1+RV5)[(3.88±0.73)mV vs.(2.24±0.34)mV],and significant lower Apelin[(1.10±0.25)pg/ml vs.(1.58±0.17)pg/ml]level(P<0.001 all).ROC curve indicated that the area under the curve(AUC)of combined detection of above five indexes diagnosing HCM was 0.933(95%CI 0.895~0.961),significantly higher than any single detection(Z=3.681~6.428,P<0.001 all),the H-L goodness of fit test showed P=0.056,suggesting that the model was well accepted,and DCA showed that ET-1 and Apelin combined ECG detection model had good clinical application value in HCM.Multivariate Logistic regression indicated that ET-1,ΣQRS,SV3+RaV and SV1+RV5 were independent risk factors for death within 6-month in HCM patients(OR=2.617~3.600,P<0.001 all),and Apelin was its ind

关 键 词：心肌病 肥厚性 内皮缩血管肽1 脂肪因子类 心电描记术 

分 类 号：R542.2[医药卫生—心血管疾病]