老年慢性心力衰竭患者血清人类母系表达基因3的水平与预后的相关性研究

目的　探讨老年慢性心力衰竭（ chronic heart failure，CHF）患者血清人类母系表达基因 3（maternally expressed gene 3，MEG3）表达与预后的相关性。方法　回顾性分析 2019年 1月～ 12月保定市第二医院收治的 118例 CHF患者的临床资料。比较 NYHA分级Ⅱ级和Ⅲ级患者的血清肌酸激酶同工酶（ creatine kinase isoenzyme-MB，CKMB）、心肌肌钙蛋白 I（cardiac troponin I，cTnI）、B型尿钠肽（ B-type natriuretic peptide，BNP）、MEG3表达、左室收缩末期内径（ left ventricular end-systolic dimension，LVESD）、左室舒张末期内径（ left ventricular end-diastolic dimension，LVEDD）、左室射血分数（ left ventricular ejection fractions，LVEF）。采用 Spearman相关性分析上述指标与心功能分级的相关性。根据患者随访 12个月期间是否出现心脏事件分为预后不良组和预后良好组，比较两组临床资料，采用多因素 Logistic回归分析确定预后影响因素，绘制血清 MEG3表达预测老年 CHF预后的 ROC曲线。结果　与心功能Ⅱ级相比较，心功能Ⅲ级患者血清 CK-MB（57.70±5.46 IU/L vs 68.19±6.53 IU/L），cTnI（1.95±0.47 ng/L vs 2.37±0.63 ng/L），BNP（336.43±67.38 pg/ml vs 581.21±98.73 pg/ml），MEG3表达（ 7.32±2.25 vs 11.65±3.09）及 LVESD（39.63±7.28 mm vs 44.18±8.4 mm），LVEDD（53.05±8.78 mm vs 58.73±9.02 mm）升高， LVEF（43.19%±5.66% vs 37.55%±5.94%）降低，差异具有统计学意义（ t= 2.690～ 12.932，均 P＜ 0.05）。经 Spearman相关分析，心功能分级与 CK-MB，cTnI，BNP，MEG3表达及 LVESD，LVEDD均呈显著正相关（ r = 0.339～ 0.472，均 P＜ 0.05），与 LVEF呈显著负相关（ r = -0.443，P＜ 0.05）。与预后良好组相比，预后不良组患者中年龄 71～ 80岁占比（ 32.93% vs 55.56%）和 NYHA分级Ⅲ级占比（ 65.85% vs 88.89%），血清 CK-MB（56.91±6.76 IU/L vs 84.84±9.79 IU/L），cTnI（1.87±0.44 ng/L vs 3.14±0.87 ng/L）， BNP（320.91±74.13 pg/ml vs 956.53±121.72 pg/ml）， MEG3表达（ 7.19±2.04 vs 17.96±4.81）和 LVESD（36.75±7.79 mm vs 57.06±10.05 mm），LVEDD（52.59±7.11 mm vs 67.67±9.46 mm）升高，LVEF（42.38%±5.93 % vs 31.56%±4.43 %）降低，差异均有统计学意义（ χ2=5.345，6.716，t= 7.876～ 27.650，均 P<0.05）。多因素 Logistic回归分析显示，年龄（ OR=3.615，95%CI:1.189～ 10.991），NYHA分级（ OR=3.911， 95%CI:1.324～ 11.553），血清 CK-MB（OR=3.554，95%CI:1.397～ 9.041），cTnI（OR=4.193，95%CI:1.583～ 11.106）， BNP（OR=2.842，95%CI:1.319～ 6.124），MEG3表达（ OR=5.003，95%CI:1.297～ 19.298），LVEF（OR=0.396， 95%CI:0.184～ 0.876）是预后影响因素（均 P＜ 0.05）。血清 MEG3表达预测 CHF预后的曲线下面积 0.874（95%CI: 0.778～ 0.948），当血清 MEG3表达 =12.52×2-△△ Ct时，敏感度与特异度最高，分别为 0.869，0.724。结论　年龄、 NYHA分级、血清 CK-MB，cTnI，BNP，MEG3表达及 LVEF是 CHF患者的预后影响因素，积极检测血清 MEG3表达有利于预测患者预后。

Study on the Correlation between Serum Human Maternally Expressed Gene 3 Levels and Prognosis in Elderly Patients with Chronic Heart Failure

Objective　To investigate the relationship between the expression of serum human maternally expressed gene 3 (MEG3) and prognosis in elderly patients with chronic heart failure (CHF). Methods　The clinical data of 118 CHF patients admitted to the Second Hospital of Baoding from January 2019 to December 2019 were retrospectively analyzed. The serum creatine kinase isoenzyme (CK-MB), cardiac troponin I (cTnI), B-type natriuretic peptide (BNP), MEG3 expression, and left ventricular end-systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) were compared in NYHA grade II and III patients. Spearman correlation was used to analyze the correlation between the above indicators and the classification of cardiac function. Patients were divided into poor prognosis group and good prognosis group according to whether there were cardiac events during the 12-month follow-up period. The clinical data of the two groups were compared, multivariate logistic regression analysis was used to determine the prognostic factors, and the ROC curve of serum MEG3 expression to predict the prognosis of elderly CHF was drawn. Results　Compared with cardiac function grade II, serum CK-MB in patients with cardiac function grade III (57.70±5.46 IU/L vs 68.19±6.53 IU/L), cTnI (1.95±0.47 ng/L vs 2.37±0.63 ng/L), BNP (336.43±67.38 pg/ml vs 581.21±98.73 pg/ml), MEG3 expression (7.32±2.25 vs 11.65±3.09) and LVESD (39.63±7.28 mm vs 44.18±8.4 mm), LVEDD (53.05±8.78 mm vs 58.73±9.02 mm) were increased, the LVEF (43.19%±5.66% vs 37.55%±5.94%) was decreased, the difference were statistically significant (t = 2.690 ~ 12.932, all P<0.05). According to Spearman correlation analysis, cardiac function classification was significantly positively correlated with CK-MB, cTnI, BNP, MEG3 expression and LVESD, LVEDD (r = 0.339 ~ 0.472, all P<0.05), and significantly negatively correlated with LVEF (r =-0.443, P<0.05). Compared with the good prognosis group, the proportion of patients aged 71 to 80 years old in poor prognosis group (32.93% vs 55.56%) and the proportion of NYHA grade III (65.85% vs 88.89%), serum CK-MB (56.91±6.76 IU/L vs 84.84±9.79 IU/L), cTnI (1.87±0.44 ng/L vs 3.14±0.87 ng/L), BNP (320.91±74.13 pg/ml vs 956.53±121.72 pg/ml), MEG3 expression (7.19±2.04 vs 17.96±4.81), LVESD (36.75±7.79 mm vs 57.06±10.05 mm), LVEDD (52.59±7.11 mm vs 67.67±9.46 mm) were increased, the LVEF (42.38%±5.93% vs 31.56%±4.43%) was decreased, the difference were statistically significant (χ2=5.345, 6.716, t = 7.876 ~ 27.650, all P<0.05). Multivariate logistic regression analysis showed that age (OR=3.615, 95%CI: 1.189 ~ 10.991), NYHA classification (OR=3.911, 95%CI: 1.324 ~ 11.553), serum CK-MB (OR=3.554, 95%CI: 1.397 ~ 9.041), cTnI (OR=4.193, 95%CI: 1.583 ~ 11.106), BNP (OR=2.842, 95%CI: 1.319 ~ 6.124), MEG3 expression (OR=5.003, 95%CI: 1.297 ～ 19.298), LVEF (OR=0.396, 95%CI: 0.184 ～ 0.876) were prognostic factors ( all P<0.05). The area under the curve of serum MEG3 expression predicting the prognosis of CHF was 0.874 (95%CI: 0.778 ~ 0.948). When serum MEG3 expression=12.52×2- △△ Ct, the sensitivity and specificity were 0.869 and 0.724 respectively for the highest. Conclusion　 The age, NYHA grade, serum CK-MB, cTnI, serum BNP, MEG3 expression, LVEF are the prognostic factors of CHF patients. Active detecting the serum MEG3 expression level of patients has great predictive value for the prognosis of patients.