摘要
目的探讨血清胆碱酯酶(Ch E)、前白蛋白(PA)对急性失代偿性心力衰竭(ADHF)预后评估的价值。方法选取2017年5月至2019年10月中国人民解放军联勤保障部队第九八八医院收治的200例ADHF患者为研究对象,根据6个月主要不良心血管事件(MACE)发生情况分为非MACE组(139例)和MACE组(61例),采用纽约心脏病协会(NYHA)标准进行心功能分级,记录左室射血分数(LVEF)和血清Ch E、PA水平,分析ADHF患者血清Ch E、PA水平与LVEF、NYHA分级的相关性;绘制受试者工作特征(ROC)曲线评估血清Ch E、PA对ADHF患者发生MACE的预测价值;采用Logistic回归模型分析影响ADHF患者发生MACE的危险因素。结果与非MACE组比较,MACE组NYHAⅣ级构成比、LVESD、LVEDD较高(P<0.05),LVEF及血清Ch E、PA水平较低(P<0.05)。ADHF患者血清Ch E、PA水平与LVEF呈正相关(P<0.05),与LVESD、LVEDD、NYHA分级呈负相关(P<0.05)。血清Ch E、PA单独及两者联合预测ADHF患者发生MACE的曲线下面积(AUC)分别为0.816、0.808、0.887,Ch E单独预测的截断值为3155.39U/L,敏感度、特异度分别为73.80%、74.80%;PA单独预测的截断值为160.94 mg/L,敏感度、特异度分别为80.30%、66.90%;两者联合预测的敏感度为86.90%,特异度为74.80%,Ch E、PA联合预测较单独预测敏感度高。LVEF≤35%、Ch E低水平、PA低水平是影响ADHF患者发生MACE的危险因素(P<0.05)。结论血清Ch E、PA低水平是影响ADHF患者预后发生MACE的危险因素,可能成为预测ADHF患者预后的辅助指标。
Objective To evaluate the value of serum cholinesterase( Ch E) and prealbumin( PA) in prognosis evaluation of acute decompensated heart failure( ADHF). Methods A total of 200 patients with ADHF admitted to our hospital from May 2017 to October 2019 were selected as the research objects. According to the incidence of major adverse cardiovascular events( MACE) in 6 months,they were divided into two groups: non-MACE group( 139 cases) and MACE group( 61 cases). Cardiac function was graded according to the New York Heart Association( NYHA),LVEF,the expression levels of Ch E and PA in serum were recorded. Pearson and Spearman were used to analyze the correlation between serum Ch E,PA expression levels and LVEF,NYHA grading in the patients with ADHF;receiver operating characteristic( ROC) curve was drawn to evaluate the predictive value ofserum Ch E and PA for MACE in the patients with ADHF;Logistic regression model was used to analyze the influencing factors of MACE in the patients with ADHF. Results Compared with those in the non-MACE group,the proportion of NYHA grade IV,LVESD and LVEDD in MACE group was higher( P<0. 05),LVEF and expression levels of serum Ch E and PA were lower( P<0. 05);the levels of serum Ch E and PA were positively correlated with LVEF( P<0. 05),and negatively correlated with NYHA grade,LVESD and LVEDD( P<0. 05);the area under the curve( AUC) of serum Ch E and PA alone or combined to predict MACE in the patients with ADHF was 0. 816,0. 808 and 0. 887,respectively,the cut-off value of Ch E alone was 3155. 39 U/L,and the sensitivity and specificity were 73. 80% and74. 80%,respectively,the cut-off value of PA was 160. 94 mg/L,the sensitivity and specificity were80. 30% and 66. 90%,respectively,the sensitivity and specificity of combined prediction were 86. 90%and 74. 80%,respectively,the sensitivity of combined prediction was higher than that of Ch E and PA alone;LVEF≤35%,low level of Ch E and low level of PA were independent risk factors of MACE in the patients with ADHF( P<0. 05). Conclusions The low levels of serum Ch E and PA are independent risk factors affecting the prognosis of patients with ADHF,and may be the auxiliary indicators for predicting the prognosis of patients with ADHF.
作者
李运正
丁科
孙登科
张志鹏
厍飞
Li Yun-zheng;Ding Ke;Sun Deng-ke;Zhang Zhi-peng;She Fei(Department of Emergency Medicine,the 98th Joint Logistic Support Force of the Chinese People's Liberation Army,Zhengzhou 450000,China)
出处
《中国急救医学》
CAS
CSCD
2021年第6期474-478,共5页
Chinese Journal of Critical Care Medicine
