老年心衰并发心律失常患者血清Ang-2，CysC水平及hs-CRP/PAB比值对临床预后评估的价值研究

目的　探究老年慢性心力衰竭（CHF）并发心律失常患者血清血管生成素2（Ang-2）、胱抑素C（Cys C）和超敏C反应蛋白/前清蛋白（hs-CRP/PAB）比值对患者预后的评估价值。方法　选取2017年1月～2020年1月蓬莱市人民医院收治的117例老年CHF并发心律失常患者，按照NYHA分级分为NYHAⅡ组（n=34），NYHA Ⅲ组（n=52）和NYHAⅣ组（n=31），另选同期体检健康人员37例作为健康对照组，采用ELISA法测定血清Ang-2水平，采用化学发光微粒子免疫法检测BNP，采用免疫比浊法检测Cys C，hs-CRP和PAB水平。收集患者临床资料，记录出院后6个月是否发生心衰复发或心源性死亡（SCD）。采用单因素方差分析比较不同NYHA分级患者血清Ang-2，CysC和hs-CRP/PAB差异，采用Pearson及Spearman检验分析血清Ang-2，Cys C，hs-CRP/PAB与BNP，LVEF，NYHA分级相关性，建立ROC曲线分析血清Ang-2，Cys C和hs-CRP/PAB对预测CHF预后的临床价值。结果　各病例组血清Ang-2，Cys C，hs-CRP/PAB，BNP高于对照组，LVEF低于对照组，且以上指标在不同NYHA分级患者中差异均有统计学意义（F=7.98，8.27，8.36，8.55，9.74，均P<0.05）；Pearson相关性分析显示，血清Ang-2，Cys C，hs-CRP/PAB与BNP呈正相关（r=0.635，0.448，0.649，均P<0.05），与LVEF呈负相关（r=-0.571，-0.645，-0.627，均P<0.05），Spearman相关性分析显示，血清Ang-2，Cys C和hs-CRP/PAB与NYHA分级呈正相关（r=0.713，0.633，0.584，均P<0.05）；预后不良患者血清Ang-2，hs-CRP/PAB，Cys C高于预后良好患者，差异均有统计学意义（t=2.953，3.738，9.768，均P<0.05）；绘制血清Ang-2，Cys C和hs-CRP/PAB预测预后的ROC曲线，其AUC分别为0.713，0.737和0.670，联合检测的AUC为0.860。结论　老年心律失常型心衰患者血清Ang-2，CysC和hs-CRP/PAB表达与其病情严重程度有关，且对临床预后具有一定的预测价值。

Value of Serum Ang-2, Cys C and Hs-CRP/PAB Ratio in the Evaluation of Clinical Prognosis in Elderly Patients with Heart Failure Complicated by Arrhythmia

Objective　To investigate the value of angiopoietin 2 (Ang-2), cystatin C (Cys C), hypersensitive C-reactive protein/prealbumin (hs-CRP/PAB) ratio in the evaluation of elderly patients with chronic heart failure (CHF) combined with arrhythmia. Methods　A total of 117 elderly CHF patients with arrhythmia admitted to Penglai People’s Hospital from January 2017 to January 2020 were selected and divided into NYHAⅡ group (n=34), NYHAⅢ group (n=52) and NYHAⅣgroup (n=31) according to NYHA classification, and 37 healthy people during the same period were selected as healthy controls. Serum Ang-2 levels were determined by ELISA, BNP was detected by chemiluminescence microparticle immunoassay, and Cys C, hs-CRP and PAB levels were detected by immunoturbidimetric method. The clinical data of patients were collected, to recorded whether heart failure recurrence or cardiac death (SCD) occurred 6 months after discharge. The differences of serum Ang-2, Cys C and hs-CRP/PAB in patients with different NYHA grades were compared by one-way ANOVA Pearson and Spearman tests were used to analyze the correlation between serum Ang-2, Cys C, hs-CRP/PAB and BNP, LVEF, NYHA grades. ROC curve was established to analyze the clinical value of serum Ang-2, Cys C and hs-CRP/PAB in predicting the prognosis of CHF. Results　Serum Ang-2, Cys C, hs-CRP/PAB and BNP in each case group were higher than those in the control group, and LVEF was lower than the control group. Those values were significantly different in patients with various NYHA grade (F=7.98，8.27，8.36，8.55，9.74, all P<0.05). Pearson correlation analysis showed that serum Ang-2, Cys C, hs-CRP/PAB and BNP were positively correlated (r=0.635, 0.448, 0.649, all P<0.05), and negatively correlated with LVEF (r=-0.571, -0.645, -0.627, P<0.05). Spearman correlation analysis showed that serum Ang-2, Cys C and hs-CRP/PAB were positively correlated with NYHA grade (r=0.713, 0.633, 0.584, all P<0.05), and serum Ang-2, CysC and hs-CRP/PAB in patients with poor prognosis were higher than those with good prognosis (t=2.953，9.768，3.738, all P<0.05).The ROC curves of serum Ang-2, Cys C and hs-CRP/PAB to predict prognosis were plotted. The AUCs were 0.713, 0.737 and 0.670, respectively, and the combined AUC was 0.860. Conclusion　Expressions of serum Ang-2, Cys C and hs-CRP/PAB in elderly patients with chronic heart failure are related to its diease conditions, and have a certain predictive value for their clinical prognosis.