青海高原地区不同海拔世居藏族和汉族慢性心力衰竭患者血清N末端脑钠肽前体、超敏C反应蛋白及炎性因子水平变化及其与预后的关系研究

背景心力衰竭患者血清N末端脑钠肽前体(NT-proBNP)、超敏C反应蛋白(hs-CRP)及炎性因子水平存在明显异常,但关于其在青海高原地区不同海拔世居藏族、汉族慢性心力衰竭患者中变化研究报道较少见。目的探讨青海高原地区不同海拔世居藏族、汉族慢性心力衰竭患者血清NT-proBNP、hs-CRP及炎性因水平变化及其与预后的关系。方法选取2013年6月—2015年6月于青海省心脑血管病专科医院住院治疗及高原健康体检中心体检的藏族、汉族慢性心力衰竭患者180例,比较不同海拔、民族患者一般资料(包括性别、年龄、体质量、收缩压、舒张压)及血清NT-proBNP、hs-CRP、肿瘤坏死因子α(TNF-α)、白介素6(IL-6)水平;随访3年,比较不同临床特征患者3年生存率;青海高原地区世居藏族、汉族慢性心力衰竭患者预后的影响因素分析采用多因素Cox比例风险回归分析,并绘制Kaplan-Merier生存曲线以分析青海高原地区世居藏族、汉族慢性心力衰竭患者生存情况。结果不同海拔、民族患者舒张压及血清NT-proBNP、hs-CRP、TNF-α水平及不同海拔患者IL-6水平比较,差异有统计学意义(P<0.05)。不同纽约心脏病协会(NYHA)分级,血清NT-proBNP、hs-CRP、TNF-α、IL-6水平,海拔及有无高血压、糖尿病、冠心病、高原性心脏病、慢性肾衰竭、贫血患者3年生存率比较,差异有统计学意义(P<0.05)。多因素Cox比例风险回归分析结果显示,NT-proBNP〔HR=0.02,95%CI(0,0.23)〕、TNF-α〔HR=6.45,95%CI(1.47,28.25)〕及海拔{3001~4000 m〔HR=0.23,95%CI(0.06,0.89)〕,>4000 m〔HR=0.31,95%CI(0.11,0.84)〕}是青海高原地区世居藏族、汉族慢性心力衰竭患者预后的独立影响因素(P<0.05)。Kaplan-Merier生存曲线分析结果显示,血清NT-proBNP水平<258 ng/L患者3年累积生存率高于血清NT-proBNP水平≥258 ng/L者(χ2=7.824,P<0.05),血清TNF-α水平<32 ng/L患者3年累积生存率高于血清TNF-α水平≥32 ng/L水平者(χ2=13.817,P<0.01);不同海拔患者3年累积生存率比较,差异有统计学意义(χ2=55.445,P<0.01)。结论青海高原地区海拔越高则世居藏族、汉族慢性心力衰竭患者血清NT-proBNP、hs-CRP、TNF-α、IL-6水平越高,且汉族患者高于藏族患者;高血清NT-proBNP、TNF-α水平及高海拔是青海高原地区世居藏族、汉族慢性心力衰竭患者预后不良的危险因素。

Changes and Relations to Prognosis of Serum Levels of NT-proBNP,hs-CRP and Inflammatory Cytokines in Zang and Han Nationality Chronic Heart Failure Patients with Different Living Altitude in Qinghai Plateau

Background Serum levels of NT-proBNP,hs-CRP and inflammatory cytokines are obviously abnormal in patients with heart failure,but there are few reports about changes of the above index in Zang and Han nationality chronic heart failure patients with different living altitude in Qinghai Plateau.Objective To investigate the changes and relations to prognosis of serum levels of NT-proBNP,hs-CRP and inflammatory cytokines in Zang and Han nationality chronic heart failure patients with different living altitude in Qinghai Plateau.Methods From June 2013 to June 2015,a total of 180 Zang and Han nationality chronic heart failure patients were selected in Qinghai Provincial Cardiovascular and Cerebrovascular Diseases Hospital,including some patients receiving physical examination in the Plateau Health Physical Examination Center.General information(including gender,age,body mass,SBP and DBP)as well as serum levels of NT-proBNP,hs-CRP,TNF-αand IL-6 were compared in patients with different living altitude and nationalities;3-year survival rate was compared in patients with different clinical characteristics after the 3-year follow-up;multivariate Cox proportional hazards regression analysis was used to analyze the influencing factors of prognosis in Zang and Han nationality chronic heart failure patients living in Qinghai Plateau,and Kaplan-Meier survivorship curve was draw to analyze the survival situation.Results There was statistically significant differences in DBP,serum levels of NT-proBNP,hs-CRP,TNF-αin patients with different living altitude and nationalities,respectively,and there was statistically significant differences in IL-6 in patients with different living altitude and nationalities,respectively(P<0.05).There was statistically significant difference in 3-year survival rate in patients with different NYHA grades,serum level of NT-proBNP,of hs-CRP,of TNF-α,of IL-6,living altitude,merged with hypertension,diabetes,coronary heart disease,high altitude heart disease,chronic renal failure and anemia or not,respectively(P<0.05).Multivariate Cox proportional hazards regression analysis results showed that,NT-proBNP〔HR=0.02,95%CI(0,0.23)〕,TNF-α〔HR=6.45,95%CI(1.47,28.25)〕and living altitude{3001~4000 m〔HR=0.23,95%CI(0.06,0.89)〕,>4000 m〔HR=0.31,95%CI(0.11,0.84)〕}were independent influencing factors of prognosis in Zang and Han nationality chronic heart failure patients living in Qinghai Plateau(P<0.05).Kaplan-Merier survivorship curve showed that,3-year cumulative survival rate in patients with serum NT-proBNP level<258 ng/L was statistically significantly higher than that in patients with serum NT-proBNP level≥258 ng/L(χ2=7.824,P<0.05),meanwhile 3-year cumulative survival rate in patients with TNF-αlevel<32 ng/L was statistically significantly higher than that in patients with serum TNF-αlevel≥32 ng/L(χ2=13.817,P<0.01),moreover there was statistically significantly difference in 3-year cumulative survival rate in patients with different living altitude(χ2=55.445,P<0.01).Conclusion As the living altitude increase,serum levels of NT-proBNP,hs-CRP,TNF-αand IL-6 increases in Zang and Han nationality chronic heart failure patients in Qinghai Plateau,and the above four in Han nationality are significantly higher than those in Zang nationality patients;elevated serum levels of NT-proBNP and TNF-αas well as high altitude are risk factors of poor prognosis in Zang and Han nationality chronic heart failure patients in Qinghai Plateau.