摘要
目的 探讨乏氧诱导因子(HIF)-1α、生长分化因子(GDF)-15及脂质运载蛋白(LCN)-2在急性左心衰竭(ALHF)病程中表达的意义,并分析其对预后的预测价值.方法 回顾性分析2016年9月至2018年8月呼和浩特市第一医院心内科收治的90例ALHF患者的临床资料,设为观察组;另回顾性分析同期45名健康受试者的临床资料,设为对照组;对比两组性别、年龄、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、氨基末端脑钠肽前体(NT-proBNP)及血清HIF-1α、GDF-15、LCN-2水平,并采用Pearson相关系数法分析ALHF患者HIF-1α、GDF-15、LCN-2与LVEF、LVEDD、NT-proBNP水平的相关性;根据ALHF患者1年内生存情况将其分为生存组和死亡组,对比两组血清HIF-1α、GDF-15、LCN-2水平,并通过绘制受试者工作特征曲线(ROC),评估HIF-1α、GDF-15、LCN-2水平对ALHF患者1年内发生不良结局的预测价值.结果观察组LVEF水平低于对照组[(49.62±8.30)%比(67.42±7.25)%,P<0.05],LVEDD、NT-proBNP水平高于对照组[(60.38±9.70)mm比(44.16±3.19)mm,(2130.55±312.47)ng/L比(125.84±14.02)ng/L,P<0.05];观察组血清HIF-1α、GDF-15、LCN-2水平高于对照组,差异均有统计学意义[(28.62±5.61)ng/L比(5.20±1.12)ng/L,(2352.60±344.36)ng/L比(1052.89±150.18)ng/L,(156.47±27.10)μg/L比(32.50±6.19)μg/L,P<0.05];HIF-1α、GDF-15、LCN-2与LVEF呈负相关(P<0.05);HIF-1α、GDF-15与LVEDD、NT-proBNP均呈正相关(P<0.05);LCN-2与NT-proBNP呈正相关(P<0.05),与LVEDD无相关性(P>0.05).ALHF出院1年内病死率为15.56%,死亡组血清HIF-1α、GDF-15、LCN-2水平高于生存组,差异均有统计学意义[(47.19±7.30)ng/L比(25.20±4.21)ng/L,(4562.50±534.28)ng/L比(1945.51±210.42)ng/L,(243.18±33.17)μg/L比(140.50±22.93)μg/L,P<0.05];HIF-1α、GDF-15、LCN-2预测ALHF患者1年内发生不良结局的最佳截断点分别为39.05 ng/L、4390.21 ng/L、206.80μg/L,敏感度分别为71.43%、57.14%、64.29%,特异度分别为88.16%、80.26%、75.00%,准确度分别为85.56%、76.67%、73.33%,AUC分别为0.750、0.706、0.648.结论 HIF-1α、GDF-15、LCN-2在ALHF患者中异常高表达,三者对评估ALHF预后有一定临床价值,可作为评估ALHF的参考指标.
Objective To investigate the significance of hypoxia-inducible factor(HIF)-1α,growth differentiation factor(GDF)-15 and lipocalin(LCN)-2 expression in the course of acute left heart failure(ALHF)and the value in prognosis prediction.Methods The clinical data of 90 patients with ALHF treated in the Department of Cardiolog,Hohhot First Hospital from September 2016 to August 2018 were reviewed.They were divided into observation group.The clinical data of 45 healthy subjects were as control group.The sex,age,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),N-terminal pro-brain natriuretic peptide(NT-proBNP),serum levels of HIF-1α.GDF-15 and LCN-2 were compared between the two groups.The correlation between HIF-1α,GDF-15 and LCN-2 and LVEF,LVEDD,NT-proBNP in ALHF patients was analyzed by Pearson correlation coefficient method.According to the one-year survival of ALHF patients,they were divided into survival group and death group.The serum levels of HIF-la,GDF-15 and LCN-2 were compared between the two groups.The predictive value of HIF-la,GDF-15 and LCN-2 for adverse outcomes in ALHF patients during one year was evaluated by drawing subject working characteristic curve(ROC).Results The level of LVEF in observation group was lower than that in control group[(49.62±8.30)%vs.(67.42±7.25)%,P<0.05]and the levels of LVEDD and NT-proBNP were higher than those in control group[(60.38±9.70)mm vs.(44.16±3.19)mm,(2130.55±312.47)ng/L vs.(125.84±14.02)ng/L,P<0.05].The serum levels of HIF-1α,GDF-15 and LCN-2 in observation group were higher than those in control group[(28.62±5.61)ng/L vs.(5.20±1.12)ng/L,(2352.60±344.36)ng/L vs.(1052.89±150.18)ng/L,(156.47±27.10)pg/L vs.(32.50±6.19)jig/L,P<0.05].HIF-1α,GDF-15 and LCN-2 were negatively correlated with LVEF(P<0.05).HIF-la and GDF-15 were positively correlated with LVEDD and NT-proBNP(P<0.05).LCN-2 was positively correlated with NT-proBNP(P<0.05),while LCN-2 was not correlated with LVDD(P>0.05).The mortality rate of ALHF within one year after discharge was 15.56%.The serum levels of HIF-la,GDF-15 and LCN-2 in the death group were higher than those in the survival group[(47.19±7.30)ng/L vs.(25.20±4.21)ng/L,(4562.50±534.28)ng/L vs.(1945.51±210.42)ng/L,(243.18±337)yg/Lvs.(140.50±22.93)ng/L,P<0.05].The best cut-off points of HIF-1α,GDF-15 and LCN-2 for predicting adverse outcomes in ALHF patients within one year were 39.05 ng/L,4390.21 ng/L and 206.80μg/L,with sensitivity of 71.43%,57.14%and 64.29%,specificity of 88.16%,80.26%and 75.00%,accuracy of 85.56%,76.67%and 73.33%,AUC of 0.750,0.706 and 0.648.Conclusion HIF-1α,GDF-15 and LCN-2 are abnormally highly expressed in patients with ALHF and certain clinical value for the prognosis of ALHF,which can be used as a reference index for evaluating ALHF.
作者
沈剑虹
李赞飞
任贤亮
SHEN Jian-hong;LI Zan-fei;REN Xian-liang(Department of Cardiology,Hohhot First Hospital,Hohhot 010030,China)
出处
《中国心血管病研究》
CAS
2020年第3期236-240,共5页
Chinese Journal of Cardiovascular Research
