摘要
目的探讨血清组织型金属蛋白酶抑制剂4(TIMP-4)水平对老年慢性心力衰竭(CHF)早期诊断及预后评估的价值。方法选择老年CHF患者160例(CHF组),其中轻度68例、重度92例,另选体检健康的老年志愿者40例(对照组)。采用彩色多普勒超声诊断仪检测两组左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)。采集肘静脉血,采用双抗体夹心ELISA法检测血清TIMP-4。采用受试者工作特征(ROC)曲线分析血清TIMP-4对老年CHF的早期诊断价值。老年CHF患者出院3、6、9个月复查心脏彩超,统计心脏事件的发生情况。结果 CHF组LVEDD明显高于对照组,LVEF、TIMP-4明显低于对照组,以重度CHF患者上述指标变化更明显(P均<0.05);相关分析显示,老年CHF患者血清TIMP-4水平与LVEF呈正相关关系(r=0.816,P<0.05),与LVEDD呈负相关关系(r=-0.266,P<0.05)。ROC曲线分析显示,血清TIMP-4诊断老年CHF的曲线下面积为0.916(95%CI:0.869~0.951),其cut off值为1.41 ng/m L,此时血清TIMP-4诊断老年CHF的敏感性为77.0%、特异性为92.0%。以血清TIMP-4水平的cut off值为截断值,将老年CHF患者分为TIMP-4高水平者(TIMP-4>1.41ng/m L)46例和TIMP-4低水平者(TIMP-4≤1.41 ng/m L)114例;TIMP-4高水平者和TIMP-4低水平者出院3个月无心脏事件生存率比较P>0.05,而TIMP-4高水平者出院6、9个月无心脏事件生存率明显高于TIMP-4低水平者(P均<0.05)。结论血清TIMP-4可作为老年CHF患者早期诊断和预后判断的预测指标之一。
To explore the value of tissue inhibitor of metalloproteinase-4（ TIMP-4） in the early diagnosis and prognosis of elderly patients with chronic heart failure（ CHF）. Methods A total of 160 cases of elderly CHF patients（ CHF group）including 68 cases of mild heart failure and 92 cases of severe heart failure were selected,meanwhile,another 40 health elderly people were selected as the control group. The left ventrieular end diastolic dimension（ LVEDD） and left ventricular ejection fraction（ LVEF） in the two groups were detected,the venous blood was extracted to determine the serum levels of TIMP-4 by double antibody sandwich enzyme-linked immunosorbent assay（ ELISA）. The early diagnosis value of serum TIMP-4 for CHF were analyzed by ROC curve. At 3,6,and 9 months after discharge,we reviewed the heart color Doppler ultrasound of elderly CHF patients and did the statistics of their heart events. Results The LVEDD in the CHF group was significantly higher than that of the control group,whereas LVEF and TIMP-4 were significantly lower than those of the control group,especially in the severe heart failure patients（ all P〈0. 05）; correlation analysis showed that the serum TIMP-4 level was positively correlated with LVEF（ r = 0. 816,P〈0. 05）,and was negatively correlated with LVEDD（ r =-0. 266,P〈0. 05）. ROC curve analysis showed that the area under the curve（ AUC） of serum TIMP-4 in diagnosis of elderly CHF patients was 0. 916（ 95% CI： 0. 869-0. 951） with the sensitivity of 77. 0% and the specificity of 92. 0%. The cut-off value was 1. 41 ng/mL. According to the cut-off value,we divided the elderly CHF patients in the high level TIMP-4 group（ TIMP-4〉 1. 41 ng/mL,n = 46） and low level TIMP-4 group（ TIMP-4 ≤1. 41 ng/mL,n = 114）. The 3-month cardiac event-free survival between the high level TIMP-4 group and low level TIMP-4 group was not significant different（ P〉0. 05）. The 6-month and 9-month cardiac event-free survival in the high level TIMP-4 group was s
出处
《山东医药》
CAS
北大核心
2017年第36期17-20,共4页
Shandong Medical Journal
基金
海南省卫生计生行业科研项目(16A200111)
关键词
慢性心力衰竭
组织型金属蛋白酶抑制剂4
老年人
诊断
预后
chronic heart failure
tissue inhibitor of metalloproteinase 4
elderly patients
diagnosis
prognosis
