血清suPAR水平与慢性心力衰竭患者预后的关系研究

目的探讨血清可溶性尿激酶型纤溶酶原激活物受体(suPAR)与慢性心力衰竭(CHF)患者预后的关系。方法选取2016年1月至2017年12月期间于解放军联勤保障部队第九0九医院心血管内科收治的120例CHF患者作为CHF组(n=120),另选取同期来院进行体检的120例健康体检者作为对照组(n=120)。分析对照组及CHF组血清suPAR的表达情况,探讨其与炎症因子如肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和心功能指标如左室舒张末期内径(LVEDD)、左室射血分数(LVEF)的相关性,并随访两组研究对象12个月,分析血清suPAR对CHF患者预后的评估价值。结果CHF组的血清suPAR、TNF-α、IL-6、N末端脑钠肽前体(NT-proBNP)水平以及LVEDD均明显高于对照组(P<0.05),LVEF明显低于对照组(P<0.05)。CHF患者中,NYHA分级Ⅳ级、Ⅲ级、Ⅱ级患者的血清suPAR、TNF-α、IL-6、NT-proBNP水平以及LVEDD逐渐降低,LVEF逐渐升高,两两比较差异均有统计学意义(P<0.05)。CHF患者中,血清suPAR水平与TNF-ɑ、IL-6、LVEDD、NT-proBNP均呈正相关,与LVEF呈负相关(P<0.05)。随访12个月,共28例患者发生心脏事件。预后不良组患者的血清suPAR、TNF-α、IL-6、NT-proBNP水平以及LVEDD均明显高于预后良好组,LVEF明显低于预后良好组(P<0.05)。多因素Logistic回归分析显示:suPAR水平过高及LVEF过低均是CHF患者发生心脏事件的独立危险因素(P<0.05)。受试者操作特征曲线(ROC)分析显示:血清suPAR对CHF患者预后有较高的评估价值,曲线下面积为0.798,敏感度和特异性为75.00%和77.21%。结论血清suPAR在CHF患者中表达明显上升,且是CHF患者发生心脏事件的独立危险因素,对患者的预后评估具有较高的应用价值。

Relationship between serum suPAR level and prognosis in patients with chronic heart failure

Objective To investigate the relationship between serum soluble urokinase type plasminogen activator receptor(suPAR)and prognosis in patients with chronic heart failure(CHF).Methods 120 patients with CHF admitted to 909 Hospital of PLA Joint Logistics Support Force from January 2016 to December 2017 were selected as CHF group(n=120).Another 120 health people in the same hospital during the same period were selected as control group(n=120).The expression of serum suPAR in CHF patients and its correlation with inflammatory factors tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and cardiac function left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF)was analyzed.Follow-up for 12 months,the prognostic value of serum suPAR in CHF patients was analyzed.Results The level of serum suPAR,TNF-α,IL-6,N-terminal pro-brain natriuretic peptide(NT-proBNP)and LVEDD in CHF group was significantly higher than that in control group,and LVEF was significantly lower than that in control group(P<0.05).The level of suPAR,TNF-α,IL-6,NT-proBNP and LVEDD inⅡ,ⅢandⅣpatients increased gradually,while LVEF decreased gradually,there was significant difference between the two.(P<0.05).Serum suPAR level in CHF patients was positively correlated with TNF-α,IL-6,LVEDD and NT-proBNP,but negatively correlated with LVEF(P<0.05).After 12 months of follow-up,28 patients had heart events.The serum level of suPAR,TNF-α,IL-6,NT-proBNP and LVEDD in poor prognosis group was significantly higher than that in good prognosis group,and LVEF was significantly lower than that in good prognosis group(P<0.05).Multivariate logistic regression analysis showed that:high suPAR level and low LVEF was independent risk factor for cardiac events in CHF patients(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that:serum suPAR has a high prognostic value in CHF patients.The area under curve was 0.798,and the sensitivity and specificity was 75.00%and 77.21%.Conclusion The expression of serum suPAR is increased in CHF patients,and it is an independent risk factor for cardiac events in CHF patients.It can be used to evaluate the prognosis of CHF patients.