摘要
目的 探讨急性失代偿性心力衰竭(ADHF)患者血清可溶性Axl受体酪氨酸激酶(sAxlTK)水平在评估短期预后中的临床价值。方法 选择2018年1月1日至2021年10月1日亳州市人民医院收治的老年ADHF患者238例,根据随访90 d内复合事件发生情况分为预后不良组45例和预后良好组193例。又根据血清sAxlTK最佳截断值分为高水平组80例和低水平组158例。检测血清sAxlTK、肌钙蛋白I(cTnI)和N末端B型钠尿肽前体(NT-proBNP)水平。结果 预后不良组血清sAxlTK水平明显高于预后良好组[43.89(33.95,51.44)μg/L vs 23.89(18.73,33.92)μg/L,P<0.01]。多因素logistic回归分析显示,血清cTnI和sAxlTK是ADHF患者短期预后不良的独立危险因素(OR=1.922,95%CI:1.035~3.568,P=0.039;OR=1.021,95%CI:1.008~1.034,P=0.001)。ROC曲线分析显示,血清sAxlTK、cTnI和NT-proBNP联合预测短期预后不良的曲线下面积为0.836(95%CI:0.778~0.895)。高水平组90 d内复合事件发生率明显高于低水平组(45.0%vs 5.7%,P<0.05)。Kaplan-Meier曲线分析显示,高水平组复合事件累积发生率较低水平组更高(χ^(2)=66.991,P_(log rank)<0.01)。高水平组总生存率较低水平组更低,生存预后更差(χ^(2)=16.899,P_(log rank)<0.01)。结论 老年ADHF患者入院时高血清sAxlTK水平与短期预后不良高风险有关。血清sAxlTK有希望成为短期预后不良早期预测的有用工具,且其与cTnI、NT-proBNP联合使用可进一步提高预后预测准确性。
Objective To investigate the clinical value of serum soluble Axl receptor tyrosine ki-nase(sAxlTK)in evaluating short-term prognosis in patients with acute decompensated heart failure(ADHF).Methods A total of 238elderly ADHF patients admitted to Bozhou People's Hospital from January 1,2018to October 1,2021were recruited and divided into poor prognosis group(45patients)and good prognosis group(193patients)according to the occurrence of com-plex events within 90dof follow-up.Based on the optimal cut-off value of serum sAxlTK level,they were also assigned into high level group(80cases)and low level group(158cases).Serum levels of sAxlTK,troponin I(cTnI)and N-terminal B-type natriuretic peptide precursor(NT-proBNP)were detected.Results Serum sAxlTK level was significantly higher in the poor prognosis group than the good prognosis group[43.89(33.95,51.44)μg/L vs 23.89(18.73,33.92)μg/L,P<0.01].Multivariate logistic regression analysis showed that serum cTnI and sAxlTK levels were independent risk factors for short-term poor prognosis in ADHF patients(OR=1.922,95%CI:1.035-3.568,P=0.039;OR=1.021,95%CI:1.008-1.034,P=0.001).ROC curve analysis indicated that the AUC value of combined serum sAxlTK,cTnI and NT-proBNP levels to predict short-term poor prognosis was 0.836(95%CI:0.778-0.895).The incidence of complex events within 90dwas significantly higher in the high level group than the low level group(45.0%vs 5.7%,P<0.05).Kaplan-Meier curve analysis revealed that the cumulative inci-dence of complex events was also higher in the high level group than the low level group(χ^(2)=66.991,P_(log rank)<0.01).The high level group had significantly lower overall survival rate and worse survival prognosis than the low level group(χ^(2)=16.899,P_(log rank)<0.01).Conclusion High serum sAxlTK level in elderly ADHF patients at admission is associated with a higher risk of 90-day short-term poor prognosis.Serum sAxlTK has the potential to become a useful tool for early prediction of short-term poor prognosis,and its combination with cT
作者
马同亮
韩若东
黄羽
朱德才
Ma Tongliang;Han Ruodong;Huang Yu;Zhu Decai(Department of Emergency,Bozhou People's Hospital,Bozhou 236000,Anhui Province,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2024年第3期262-266,共5页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
安徽省教育厅高校科学研究项目(2022AH050688)。
