影响老年充血性心力衰竭患者血清CA125的相关因素分析

目的 探讨老年冠心病慢性充血性心力衰竭(CHF)患者血清CA125水平与心功能等相关因素之间的关系.方法 测定178例老年冠心病CHF患者血清肿瘤标志物CA125、癌胚抗原(CEA)、甲胎蛋白(AFP)、CA199、CA15-3、CA724以及肝肾功能和N末端脑钠肽(NT-proBNP);超声心动图测定二尖瓣舒张早期E峰最大流速(Ve)、舒张晚期A峰最大流速(Va)、Ve/Va、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心室射血分数(LVEF)、左心室射血时间.所有患者根据NYHA分为Ⅰ+Ⅱ、Ⅲ、Ⅳ级3组;统计其胸腔积液、外周水肿、心房颤动的发生率.结果 (1)178例患者中血清CA125≤35 U/ml 91例,CA125中位数9.9(3.4～33.7)U/ml;＞35 U/ml 87例,中位数64.4(20.2～462.1)U/ml.CA125＞35 U/ml组NYHA心功能Ⅲ+Ⅳ级82例,Ⅰ+Ⅱ级5例;≤35 U/ml组Ⅲ+Ⅳ级7例,Ⅰ+Ⅱ级84例,组间心功能差异有统计学意义(x2=133.3,P＜0.001).CA125增高组胸腔积液、心房颤动、外周水肿的发生率高于CA125≤35 U/ml组[32.2%(28/87)、5.5%(5/91),51.7%(45/87)、9.9%(9/91),78.2%(68/87)、19.8%(18/91),P均＜0.01],NT-proBNP、LVESD、LVEF、左心室射血时间比较差异均有统计学意义[2524.0(104.0～19 308.0)、356.0(32.0～5201.1)ng/L,35(27～55)、32(26～53)mm,49%(23%～66%)、59%(42%～69%),268(210～312)、290(260～340)ms,P均＜0.05].(2)直线回归显示:血清CA125与血浆NT-proBNP、尿素氮呈正相关(r=0.3326、P=0.002,r=0.3430、P=0.002),与LVEF、左心室射血时间呈负相关(r=-0.3016、P=0.006,r=-0.3336、P=0.004).结论 老年冠心病CHF患者血清CA125随着心功能分级恶化而升高,并且与血浆NT-proBNP水平、LVEF、左心室射血时间以及有无胸腔积液、心房颤动、外周水肿等因素有关.

Abstract：

Objective To assess the association between serum levels of carbohydrate antigen 125 (CA125) and the heart function in the elderly with congestive heart failure (CHF). Methods CA125, carcinoembryonic antigen (CEA) ,alpha-fetoprotein ( AFP), CA199, CA15-3, CA724, liver and kidney function and NT-proBNP were measured in 178 patients with heart failure. Ve, Va, Ve/Va, left ventricular end-diastolic diamete ( LVEDD), left ventricular end-systolic diamete ( LVESD ), left ventricular ejection fraction ( LVEF ) and time were measured using echocardiograph. All patients were classified as Ⅰ + Ⅱ , Ⅲ and Ⅳ level according to the criteria of New York Heart Assocation ( NYHA), and the incidence of pleural effusion, peripheral edema,atrial fibrillation were observed. Results Among the 178 patients,serum CA125 were ≤35 U/ml in 91 patients with median of 9.9( 3.4 - 33.7 ) U/ml, ＞ 35 U/ml in 87 patients with median of 64. 4 ( 20. 2 - 462. 1 ) U/ml.Among those patients with CA125 ＞ 35 U/ml ,heart function was classified as level Ⅲ + Ⅳ in 82 patients,and level Ⅰ + Ⅱ in 5 patients. Among the patients with CA125 ≤35 U/ml,heart function was classified as level Ⅲ + Ⅳin 7 patients,and level Ⅰ + Ⅱ in 84 patients. Heart function was significantly different between the two CA125 groups( x2= 133. 3 ,P ＜0. 001 ). The incidence of pleural effusion,atrial fibrillation ,peripheral edema in the higher CA125 group were 32. 2%, 51.7% and 78. 2%, respectively, which were significantly higher than those in the normal CA 125 group ( 5.5 %, 9. 9% and 19. 8 %, repactively ) ( P ＜ 0. 01 ). NT-proBNP, LVESD,LVEF and time in the higher CA125 group were 2524. 0( 104.0 - 19 308. 0) ng/L,35 (27 -55) mm,49% (23%-66% ) and 268 (210 -312)ms, which were significantly differenct from those in the normal CA125 group [356.0 ( 32.0 - 5201.0) ng/L, 32 ( 26 - 53 ) mm, 59% ( 42% - 69% ) and 290 ( 260 - 340 ) ms, respectively](Ps ＜0. 05). The linear regression showed that serum CA125 was positively correlated with NT-ProBNP and urea nitrogen ( BUN ) ( r= 0. 3326 and 0. 3430, Ps= 0. 002 ) , as well as negtively correlated with LVEF and time (r= -0. 3016,P =0. 006;r = -0. 336,P =0. 004). Conclusion Serum CA125 in the elderly with congestive heart failure increased with the worsing of heart function, and correlated with the level of NT-proBNP, LVEF and time,as well as pleural effusion, atrial fibrillation, peripheral edema.

Association of serum CA125 tumoral marker levels with heart function in the elderly with congestive heart failure

Objective To assess the association between serum levels of carbohydrate antigen 125 (CA125) and the heart function in the elderly with congestive heart failure (CHF). Methods CA125, carcinoembryonic antigen (CEA) ,alpha-fetoprotein ( AFP), CA199, CA15-3, CA724, liver and kidney function and NT-proBNP were measured in 178 patients with heart failure. Ve, Va, Ve/Va, left ventricular end-diastolic diamete ( LVEDD), left ventricular end-systolic diamete ( LVESD ), left ventricular ejection fraction ( LVEF ) and time were measured using echocardiograph. All patients were classified as Ⅰ + Ⅱ , Ⅲ and Ⅳ level according to the criteria of New York Heart Assocation ( NYHA), and the incidence of pleural effusion, peripheral edema,atrial fibrillation were observed. Results Among the 178 patients,serum CA125 were ≤35 U/ml in 91 patients with median of 9.9( 3.4 - 33.7 ) U/ml, ＞ 35 U/ml in 87 patients with median of 64. 4 ( 20. 2 - 462. 1 ) U/ml.Among those patients with CA125 ＞ 35 U/ml ,heart function was classified as level Ⅲ + Ⅳ in 82 patients,and level Ⅰ + Ⅱ in 5 patients. Among the patients with CA125 ≤35 U/ml,heart function was classified as level Ⅲ + Ⅳin 7 patients,and level Ⅰ + Ⅱ in 84 patients. Heart function was significantly different between the two CA125 groups( x2= 133. 3 ,P ＜0. 001 ). The incidence of pleural effusion,atrial fibrillation ,peripheral edema in the higher CA125 group were 32. 2%, 51.7% and 78. 2%, respectively, which were significantly higher than those in the normal CA 125 group ( 5.5 %, 9. 9% and 19. 8 %, repactively ) ( P ＜ 0. 01 ). NT-proBNP, LVESD,LVEF and time in the higher CA125 group were 2524. 0( 104.0 - 19 308. 0) ng/L,35 (27 -55) mm,49% (23%-66% ) and 268 (210 -312)ms, which were significantly differenct from those in the normal CA125 group [356.0 ( 32.0 - 5201.0) ng/L, 32 ( 26 - 53 ) mm, 59% ( 42% - 69% ) and 290 ( 260 - 340 ) ms, respectively](Ps ＜0. 05). The linear regression showed that serum CA125 was positively correlated with NT-ProBNP and urea nitrogen ( BUN ) ( r= 0. 3326 and 0. 3430, Ps= 0. 002 ) , as well as negtively correlated with LVEF and time (r= -0. 3016,P =0. 006;r = -0. 336,P =0. 004). Conclusion Serum CA125 in the elderly with congestive heart failure increased with the worsing of heart function, and correlated with the level of NT-proBNP, LVEF and time,as well as pleural effusion, atrial fibrillation, peripheral edema.