老年慢性心力衰竭患者血清LDLR、DNM2水平及临床意义

目的　探究老年慢性心力衰竭（CHF）患者血清低密度脂蛋白受体（LDLR）、发动蛋白2（DNM2）水平及临床意义。方法　选取123例CHF患者（CHF组），其中纽约心脏病学会（NYHA）分级：Ⅱ级42例、Ⅲ级61例、Ⅳ级20例。120例体检健康者（对照组）。比较各组患者血清LDLR、DNM2及心功能指标差异。Pearson相关分析LDLR、DNM2和左心室舒张末内径（LVEDD）、左心室射血分数（LVEF）及N末端B型脑钠肽前体（NT-proBNP）的相关性。CHF患者经过半年随访，分为预后良好组（98例）和预后不良组（25例），采用受试者工作特征（ROC）曲线评估LDLR、DNM2对预后不良的CHF的诊断价值。结果　不同NYHA分级亚组患者血清中的LDLR、DNM2、LVEF均较对照组下降，而LVEDD、NT-proBNP水平较对照组升高（均P＜0.05）。随着NYHA分级的增加，CHF患者血清LDLR、DNM2、LVEF水平逐渐下降，而LVEDD、NT-proBNP水平逐渐升高（均P＜0.05）。CHF患者血清LDLR、DNM2与LVEF呈正相关，而与LVEDD、NT-proBNP呈负相关（均P＜0.01）。预后不良组患者血清中LDLR、DNM2水平较预后良好组降低（P＜0.05）。ROC曲线显示，LDLR联合DNM2诊断CHF患者预后不良的曲线下面积［0.858（95%CI：0.751~0.965）］较LDLR［0.793（95%CI：0.668~0.919）］和DNM2［0.777（95%CI：0.669~0.884）］增大，敏感度和特异度均有提升。结论　CHF患者血清LDLR和DNM2水平随着NYHA分级的增加而降低，能够反映心脏功能水平，2指标联合有助于评估CHF患者预后。

The serum levels and their clinical significance of LDLR and DNM2 in elderly patients with chronic heart failure

Objective　To investigate the serum levels of low density lipoprotein receptor (LDLR) and dynamin 2 (DNM2) in elderly patients with chronic heart failure (CHF) and their clinical significance. Methods　A total of 123 CHF patients (the CHF group) and 120 healthy people (the control group) were selected. According to New York Heart Association (NYHA) classification, there were 42 cases of grade Ⅱ, 61 cases of grade Ⅲ and 20 cases of grade Ⅳ in the CHF group. The serum levels of LDLR, DNM2 and cardiac function indexes were compared between the CHF group and the control group. Pearson correlation analysis was performed to analyze the correlation between LDLR, DNM2, left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and N-terminal B-type brain natriuretic peptide precursor (NT-probNP). After six months of follow-up, CHF patients were divided into the good prognosis group (98 cases) and the poor prognosis group (25 cases). The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of LDLR and DNM2 for CHF with poor prognosis. Results　Compared with the control group, the serum levels of LDLR, DNM2 and LVEF decreased in patients with different NYHA grades than those of the control group, while the levels of LVEDD and NT-proBNP were higher than those of the control group (P＜0.05). With the increase of NYHA classification, serum levels of LDLR, DNM2 and LVEF gradually decreased in CHF patients, while LVEDD and NT-proBNP levels gradually increased (P＜0.05). Serum levels of LDLR and DNM2 were positively correlated with LVEF in CHF patients, but negatively correlated with LVEDD and NT-proBNP (P＜0.01). The serum levels of LDLR and DNM2 were lower in the poor prognosis group than those in the good prognosis group (P＜0.05). The ROC curve showed that the area under the curve of LDLR combined with DNM2 in the diagnosis of poor prognosis in CHF patients was significantly higher 0.858 (95%CI: 0.751-0.965)] than that of LDLR 0.793 (95%CI: 0.668-0.919)] and DNM2 0.777 (95%CI: 0.669-0.884)], the sensitivity and specificity were improved. Conclusion　Serum levels of LDLR and DNM2 are decreased with the the increase of NYHA classification in CHF patients, which can reflect cardiac function. The combination of the two indicators is helpful to evaluate the prognosis of patients with CHF.