摘要
目的探讨血清多配体蛋白聚糖4(SDC4)、组织蛋白酶S(CatS)水平与慢性心力衰竭(CHF)患者心室重构及预后的关系。方法选取2020年1月—2021年8月唐山市人民医院心内科收治CHF患者182例为CHF组,根据预后情况分为预后不良亚组56例和预后良好亚组126例,另选取同期健康体检者52例为健康对照组,检测各组血清SDC4、CatS水平。Pearson/Spearman相关系数分析CHF患者血清SDC4、CatS水平与心室重构指标的相关性,多因素Cox回归分析CHF患者预后不良的影响因素,受试者工作特征曲线(ROC)分析血清SDC4、CatS水平对CHF患者预后不良的预测价值。结果CHF组血清SDC4、CatS水平高于健康对照组(t=12.269、16.220,P均<0.001),预后不良亚组血清SDC4、CatS水平高于预后良好亚组(t=7.727、7.069,P均<0.001)。CHF组B型脑利钠肽(BNP)水平和左心室舒张末期内径(LVEDD)、右心室内径(RVD)、左心室质量指数(LVMI)高于健康对照组,左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)低于健康对照组(P<0.01)。相关性分析显示,CHF患者血清SDC4、CatS水平与BNP、LVEDD、RVD、LVMI呈正相关(SDC4:r=0.424、0.427、0.629、0.532;CatS:r=0.494、0.477、0.544、0.593,P均<0.001),与LVEF、LVFS呈负相关(SDC4:r=-0.549、-0.594;CatS:r=-0.506、-0.480,P均<0.001)。多因素Logistic回归分析显示,病程长、NYHA分级≥Ⅲ级、LVEDD高、LVMI高、SDC4高、CatS高为CHF患者预后不良的独立危险因素,LVEF高为独立保护因素[OR(95%CI)=1.229(1.089~1.387)、2.733(1.493~5.002)、1.119(1.008~1.241)、1.490(1.154~1.924)、1.069(1.038~1.101)、1.095(1.047~1.146)、0.715(0.594~0.860)]。ROC曲线分析显示,血清SDC4、CatS水平联合预测CHF患者预后不良的AUC大于单项预测(Z=2.832、3.100,P=0.005、0.002)。结论CHF患者血清SDC4、CatS水平升高,与心室重构和预后不良密切相关,可作为CHF患者预后不良的辅助预测指标。
Objective To investigate the relationship between serum syndecan 4(SDC4)and cathepsin S(CatS)levels and ventricular remodeling and prognosis in patients with chronic heart failure(CHF).Methods From January 2020 to August 2021,182 CHF patients admitted to the Department of Cardiology,Tangshan People's Hospital were selected as the CHF group.According to the prognosis,they were divided into a poor prognosis subgroup of 56 cases and a good prognosis subgroup of 126 cases.52 cases were healthy control group,and serum SDC4 and CatS levels in each group were detected.Pearson/Spearman correlation coefficient was used to analyze the correlation between serum SDC4 and CatS levels and ventricular remodeling indexes in CHF patients.Multivariate Cox regression analysis was used to analyze the influencing factors of poor prognosis in CHF patients.Receiver operating characteristic curve(ROC)was used to analyze serum SDC4 and CatS levels.Predictive value of poor prognosis in CHF patients.Results The levels of serum SDC4 and CatS in the CHF group were higher than those in the healthy control group(t=12.269,16.220,both P<0.001),and the levels of serum SDC4 and CatS in the poor prognosis subgroup were higher than those in the good prognosis subgroup(t=7.727,7.069,both P<0.001.0.001).The levels of B-type brain natriuretic peptide(BNP),left ventricular end-diastolic diameter(LVEDD),right ventricular diameter(RVD),and left ventricular mass index(LVMI)in the CHF group were higher than those in the healthy control group,and left ventricular ejection fraction(LVEF),Left ventricular short-axis shortening rate(LVFS)was lower than the healthy control group(P<0.01).Correlation analysis showed that serum SDC4 and CatS levels in CHF patients were positively correlated with BNP,LVEDD,RVD,and LVMI(SDC4:r=0.424,0.427,0.629,0.532;CatS:r=0.494,0.477,0.544,0.593,all P<0.001),negatively correlated with LVEF and LVFS(SDC4:r=-0.549,-0.594;CatS:r=-0.506,-0.480,both P<0.001).Multivariate Logistic regression analysis showed that long disease duration,NYH
作者
张海平
赵静敏
屠艳辉
刘京
杜雪莉
何靖蕊
Zhang Haiping;Zhao Jingmin;Tu Yanhui;Liu Jing;Du Xueli;He Jingrui(Department of Cardiology, Tangshan People's Hospital, Hebei Province, Tangshan 063000,China)
出处
《疑难病杂志》
CAS
2022年第7期700-705,710,共7页
Chinese Journal of Difficult and Complicated Cases
基金
河北省医学科学研究重点课题计划项目(20181220)。
