摘要
目的探讨连续性肾脏替代治疗(CRRT)重症心力衰竭预后及其与血清基质金属蛋白酶-8(MMP-8)、基质金属蛋白酶抑制剂-1(TIMP-1)关系。方法选取2016年1月—2019年1月行CRRT的重症心力衰竭51例作为研究组,同期进行体检的健康体检者51例作为对照组。另外,根据治疗后1年预后不同将重症心力衰竭51例分为存活组(31例)与病死组(20例)两组。观察比较研究组CRRT前1 d、CRRT后1 d和对照组外周血清MMP-8、TIMP-1水平和MMP-8/TIMP-1变化,以及存活组和病死组一般资料;采用受试者工作特征(ROC)曲线分析血清MMP-8、TIMP-1及MMP-8联合TIMP-1对CRRT重症心力衰竭患者预后预测价值;应用多因素Logistic回归分析模型探讨影响CRRT重症心力衰竭预后的相关因素。结果研究组CRRT前1 d和CRRT后1 d血清MMP-8、TIMP-1水平和MMP-8/TIMP-1均高于对照组;研究组CRRT前1 d血清MMP-8、TIMP-1水平和MMP-8/TIMP-1均高于CRRT后1 d,差异有统计学意义(P<0.01)。ROC曲线分析结果显示,血清MMP-8、TIMP-1及MMP-8联合TIMP-1对CRRT重症心力衰竭患者预后均有一定预测价值,对CRRT重症心力衰竭患者预后预测价值的曲线下面积血清MMP-8联合TIMP-1大于血清MMP-8和TIMP-1,差异均具有统计学意义(P<0.05)。存活组血清MMP-8≥41.71 ng/ml和TIMP-1≥108.25 ng/ml所占比例低于病死组,差异有统计学意义(P<0.01)。多因素Logistic回归分析结果显示,血清MMP-8≥41.71 ng/ml和TIMP-1≥108.25 ng/ml是影响CRRT重症心力衰竭患者预后的独立危险因素(P<0.05)。结论血清MMP-8、TIMP-1水平与CRRT重症心力衰竭密切相关,血清MMP-8联合TIMP-1对CRRT重症心力衰竭患者预后预测价值较高,血清MMP-8≥41.71 ng/ml和TIMP-1≥108.25 ng/ml是影响CRRT重症心力衰竭患者预后的独立危险因素。
Objective To explore prognosis of continuous renal replacement treatment(CRRT)in treatment of patients with severe heart failure(SHF)and its relationships with serum matrix metalloproteinase-8(MMP-8)and tissue inhibitor of metalloproteinase-1(TIMP-1).Methods A total of 51 SHF patients who had undergone CRRT during January 2016 and January 2019 were enrolled as research group,while another 51 healthy people who had undergone physical examination at the same period were enrolled as control group.Patients in research group were divided into survival subgroup(n=31)and death subgroup(n=20)according to different prognosis in 1 year after treatment.Changes of levels of serum MMP-8,TIMP-1 and MMP-8/TIMP-1 on the 1 st d before CRRT and on the 1 st d after CRRT were observed and compared between two groups.General data were also observed and compared between two subgroups.Values of MMP-8,TIMP-1 and MMP-8/TIMP-1 in prognosis of SHF patients treated by CRRT were analyzed by using receiver operating characteristic(ROC)curves.Multivariate logistic regression analysis model was used for analyzing influencing factors of prognosis of SHF patients after CRRT.Results Levels of serum MMP-8,TIMP-1,and MMP-8/TIMP-1 on the 1 st d before CRRT and on the 1 st d after CRRT in research group were significantly higher than those in control group,and levels of serum MMP-8,TIMP-1,and MMP-8/TIMP-1 on the 1 st d before CRRT were significantly higher than those on the 1 st d after CRRT in research group(P<0.01).Result of ROC curves analysis showed that serum MMP-8,TIMP-1 and MMP-8/TIMP-1 were of a certain value in prediction of prognosis of SHF patients after CRRT,and area under the curve(AUC)of MMP-8/TIMP-1 in predicting prognosis of SHF patients after CRRT was greater than those by MMP-8 and TIMP-1 alone(P<0.05).Proportions of patients with MMP-8 equal or more than 41.71 ng/ml and TIMP-1 equal or more than 108.25 ng/ml in survival subgroup were significantly lower than those in death subgroup(P<0.01).Result of multivariate logistic regression
作者
王焕
马娜
关阳
郑珂
WANG Huan;MA Na;GUAN Yang;ZHENG Ke(Department of Cardiology,the Fourth Hospital Affiliated to Liaoning University of Traditional Chinese Medicine,Shenyang 110101,China;Department of Orthopedics,the Fourth Hospital Affiliated to Liaoning University of Traditional Chinese Medicine,Shenyang 110101,China;Department of Critical Care Medicine,the Fourth Hospital Affiliated to Liaoning University of Traditional Chinese Medicine,Shenyang 110101,China)
出处
《临床误诊误治》
CAS
2021年第5期75-79,共5页
Clinical Misdiagnosis & Mistherapy
基金
辽宁省自然科学基金资助项目(20180540615)。
