儿茶酚抑素在慢性心力衰竭患者预后中的临床意义

目的探讨血浆儿茶酚抑素(CST)含量与慢性心力衰竭(CHF)患者预后的相关性。方法2009年1月—2012年1月诊治CHF患者128例。入院后收集患者相关临床资料及用药情况,测定血浆CST水平,并对患者出院后常规随访18个月,失访8例,依据随访期内出现主要心血管不良事件(MACE)与否分为MACE组(n=84)与非MACE组(n=36),对2组患者的临床资料进行统计学分析,以探寻CST对于CHF患者MACE的预测价值。结果2组患者性别、收缩压、血肌酐(SCr)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、心率(HR)、N-末端脑钠肽前体(NT-proBNP)及CST比较差异有统计学意义(P均<0.05)。多因素Logistic回归分析显示CST、NT-proBNP、LVEF、LVEDD是CHF患者18个月内发生MACE的独立危险因素(P<0.05)。MACE组CST水平与NT-proBNP水平呈正相关(r=0.697,P<0.05),与LVEF呈负相关(r=-0.784,P<0.05)。使用ROC曲线判定CST预测CHF患者18个月内发生MACE的几率,其曲线下面积(AUC)为0.836(95%CI 0.774⁰.886,P<0.05),CST水平为0.83μg/L时预测价值最高,灵敏度为69.41%,特异度为82.22%。Kaplan-Meier生存曲线提示CST水平≥0.83μg/L的CHF患者MACE发生率高于CST水平<0.83μg/L者(X0.886,P<0.05),CST水平为0.83μg/L时预测价值最高,灵敏度为69.41%,特异度为82.22%。Kaplan-Meier生存曲线提示CST水平≥0.83μg/L的CHF患者MACE发生率高于CST水平<0.83μg/L者(X²=3.89,P<0.05)。结论血浆CST水平升高是CHF患者18个月内发生MACE的独立危险因素,CST水平可对CHF患者的预后转归进行有效预测。

The clinical significance of plasma catestatin level on prognosis of paitents with chronic heart failure

Objective To investigate the correlation between plasma catestatin （CST） levels and prognosis of chronic heart failure （CHF） patients. Methods From 2009 January to 2012 January, 128 patients with CHF were enrolled. After ad- mission, the clinical data and drug use, the determination of plasma CST level were collected, and the patients were routine follow-up of 18 months, 8 cases were lost of follow-up, mainly on the basis of cardiovascular adverse events occurred during the follow-up period （MACE）, patients were divided into MACE group （ n = 84） and non-MACE group （ n = 36） , the clini- cal data of 2 groups were analyzed to explore the predictive value of CST for patients with CHF. Results 2 groups＇ sex, systo- lic blood pressure, serum creatinine （SCr）, left ventricular ejection fraction （LVEF）, left ventricular end diastolic diameter （LVEDD）, heart rate （HR）, N-terminal pro brain natriuretic peptide （NT-proBNP） and CST comparison was statistically sig- nificant different （ P 〈 O. 05）. Multivariate Logistic regression analysis showed that CST, NT-proBNP, LVEF, LVEDD are the independent risk factors of MACE for CHF patients within 18 month （ P 〈 O. 05）. MACE groupg CST level was positively correlated with NT-proBNP levels （ r = 0. 697, P 〈 O. 05）, and negatively correlated with LVEF （ r = - 0. 784, P 〈 O. 05）. Using the ROC curve to evaluate CST predict MACE probability of patients with CHF within 18 months, the area under the ROC curve （AUC） was 0.836 （95% CI O. 774 - 0.886, P 〈 0.05）, CST level was 0.83μg/L revealed the highest predic- tive value, the sensitivity was 69.41%, specificity was 82.22%. Kaplan-Meier survival curves indicated that CST level 〉/ 0.83μg/L, MACE incidence was higher than that of CST level 〈 0.83 μg/L in patients with CHF （ X2 = 3.89, P 〈 0.05 ）. Conclusion Elevated plasma CST levels are independent risk factors of MACE for CHF patients within 18 months, CST level to predict CHF patientg prognosis wer