文章摘要
老年慢性心力衰竭患者血清sST2、CTGF、suPAR与心功能的关系及其联合检测对心血管事件的预测价值
Relationship Between Serum sST2, CTGF, suPAR and Cardiac Function in Elderly Patients With Chronic Heart Failure and the Predictive Value of Their Combined Detection for the Cardiovascular Events
投稿时间:2022-10-20  修订日期:2022-10-20
DOI:
中文关键词: 老年  慢性心力衰竭  sST2  CTGF  suPAR  心功能  心血管事件  预测价值
英文关键词: Elderly  Chronic heart failure  sST2  CTGF  suPAR  Cardiac function  Cardiovascular events  Predictive value
基金项目:湖南省技术创新引导计划科普专项(2017ZK31447)
作者单位邮编
何新平 长沙市中心医院(南华大学附属长沙中心医院) 410004
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中文摘要:
      目的 探讨老年慢性心力衰竭(CHF)患者血清可溶性肿瘤生成抑制因子2(sST2)、可溶性尿激酶纤溶酶原激活物受体(suPAR)、结缔组织生长因子(CTGF)与心功能的关系及其联合检测对心血管事件(CVE)的预测价值。方法 选取2019年1月~2022年1月我院收治的150例老年CHF患者(CHF组),其中纽约心脏病协会(NYHA)分级Ⅱ级49例、Ⅲ级72例、Ⅳ级29例,根据随访6个月是否发生CVE分为CVE组(n=34)和非CVE组(n=116),另选取同期在我院进行体检的110例健康体检志愿者作为对照组。通过超声心动图检查左室收缩末期内径(LVESD)、左室射血分数(LVEF)、左心室舒张末期内径(LVEDD),酶联免疫吸附试验法检测血清sST2、CTGF、suPAR水平。多因素Logistic回归分析老年CHF患者发生CVE的影响因素,Pearson或Spearman相关性分析老年CHF患者血清sST2、CTGF、suPAR水平与超声心功能指标和NYHA分级的相关性,受试者工作特征(ROC)曲线分析血清sST2、CTGF、suPAR对老年CHF患者发生CVE的预测价值。结果 CHF组血清sST2、CTGF、suPAR水平和LVESD、LVEDD高于对照组,LVEF低于对照组(P<0.05)。NYHA分级Ⅱ级、Ⅲ级、Ⅳ级老年CHF患者血清sST2、CTGF、suPAR水平均依次升高(P<0.05)。 老年CHF患者血清sST2、CTGF、suPAR水平与LVEF呈负相关,与LVESD、LVEDD、NYHA分级呈正相关(P均<0.05)。NYHA分级≥Ⅲ级(OR=2.318)、N末端B型钠尿肽前体(NT-proBNP)升高(OR=1.104)、sST2升高(OR=1.641)、CTGF升高(OR=1.644)、suPAR升高(OR=1.892)为老年CHF患者CVE发生的独立危险因素,LVEF升高(OR=0.839)为其独立保护因素,差异均有统计学意义(P<0.05)。血清sST2、CTGF、suPAR单独与联合预测老年CHF患者发生CVE的曲线下面积分别为0.788、0.782、0.771、0.936。结论 老年CHF患者血清sST2、CTGF、suPAR水平升高与心功能异常和CVE发生密切相关,联合检测血清sST2、CTGF、suPAR水平对老年CHF患者发生CVE的预测价值较高。
英文摘要:
      Objective:To investigate the relationship between serum soluble suppression of tumorigenicity 2(sST2), soluble urokinase plasminogen activator receptor (suPAR),connective tissue growth factor (CTGF) and cardiac function in elderly patients with chronic heart failure (CHF) and the predictive value of their combined detection for cardiovascular events (CVE). Methods:150 elderly patients with CHF (CHF group) who were admitted to our hospital from January 2019 to January 2022 were selected, including New York Heart Association (NYHA) of 49 cases of grade Ⅱ, 72 cases of grade Ⅲ and 29 cases of grade Ⅳ. According to whether CVE occurred at 6 months of follow-up, they were divided into CVE group (n=34) and non-CVE group (n=116). Another 110 healthy volunteers who underwent physical examination in our hospital during the same period were selected as the control group. Left ventricular end systolic diameter (LVESD) , left ventricular ejection fraction (LVEF), and left ventricular end diastolic diameter (LVEDD) were detected by echocardiography. The levels of serum sST2, CTGF and suPAR were detected by enzyme-linked immunosorbent assay.Multivariate Logistic regression analysis was used to analyze the influencing factors of CVE in elderly patients with CHF. Pearson or Spearman correlation analysis was used to analyze the correlation between serum sST2, CTGF, suPAR levels and echocardiography cardiac function indexes and NYHA grade in elderly patients with CHF. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum sST2, CTGF and suPAR on CVE in elderly patients with CHF. Results:The levels of serum sST2, CTGF and suPAR, LVESD and LVEDD in the CHF group were higher than those in the control group, and LVEF was lower than that in the control group (P<0.05). The levels of serum sST2, CTGF and suPAR in elderly patients with CHF with NYHA grade Ⅱ, grade Ⅲ and grade Ⅳ were increased successively (P<0.05). The levels of serum sST2, CTGF and suPAR in elderly patients with CHF were negatively correlated with LVEF, and positively correlated with LVESD, LVEDD and NYHA grade (all P<0.05). NYHA grade ≥ grade Ⅲ (OR=2.318), elevated N-terminal pro-B-type natriuretic peptide precursor (NT-probNP) (OR=1.104), elevated sST2 (OR=1.641), elevated CTGF (OR=1.644), and elevated suPAR (OR=1.892) were the only CVE in elderly patients with CHF, the elevated LVEF (OR=0.839) was the independent protective factor, and the differences were statistically significant (P<0.05). The areas under the curve of serum sST2, CTGF and suPAR alone and jointly in predicting CVE in elderly patients with CHF were 0.788, 0.782, 0.771 and 0.936, respectively. Conclusion:The elevated serum sST2, CTGF and suPAR levels in elderly patients with CHF are closely associated with cardiac function and the occurrence of CVE. Combined detection of serum sST2, CTGF and suPAR levels has a high predictive value for the occurrence of CVE in elderly patients with CHF.
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