摘要
目的分析血清半乳糖凝集素3（Gal-3）、N端脑钠肽前体（NT-proBNP）、B型脑钠肽（BNP）、C反应蛋白（CRP）与慢性心力衰竭急性发作失代偿期（DAACHF）患者临床预后相关性和对住院30d病死率的预测价值。方法回顾性分析2012年7月至2015年6月北京大学第一医学医院与首都医科大学附属北京安贞医院心内科收治的53例死于DAACHF的患者（病死组），根据年龄、性别、心功能分级配伍原则，选择同期治疗好转的50例DAACHF患者（存活组），收集两组患者住院即刻、治疗3d、7d、14dGal-3、NT-proBNP、BNP、CRP及明尼苏达心力衰竭生活质量量表（MLHFQ），以治疗7d后上述标志物水平与MLHFQ评分进行相关性分析，并通过受试者工作特征（ROC）曲线计算上述因子对30d病死率的预测价值。结果随治疗时间延长，病死组患者Gal-3、NT-proBNP、BNP、CRP、MLHFQ评分逐渐上升，存活组上述因子及MLHFQ评分逐渐下降；病死组患者入院当天、治疗3d、7d、14d上述指标均高于对照组（P〈0．05）。治疗7d后，Gal-3、NT-proBNP、BNP、CRP与MLHFQ评分均呈正相关（r值分别为0．748、0．730、0．6872，均P〈0．01）；Gal-3、NT-proBNP、BNP、CRP与MLHFQ评分对患者病死率预判效能的ROC曲线下面积分别为0．943、0．907、0．876、0．867、0．913，均P〈0．01）。结论DAACHF患者体内Gal-3、NT-proBNP、BNP、CRP水平与不良预后呈正相关；对30d病死率的预测效能顺位为Gal-3〉NT-proBNP〉BNP〉cRP；联合动态监测可更好预测心力衰竭患者的预后。
Objective To analyze the correlation of serum levels of galectin-3 （Gal-3）, N-terminal pro brain natriuretic peptide（NT-prot3NP）, brain natriuretic peptide（BNP）and C reactive protein（CRP） with prognosis of patients with decompensated acute attack of chronic heart failure （DAACHF）, and to evaluate its significance in predicting mortality during 30-day hospitalization. Methods 103 DAACHF patients admitted in Peking University First Hospital and Capital Medical University-affiliated Beijing Anzhen Hospital Department of Cardiology from July 2012 to June 2015 were divided into death group（n= 53, died of DAACHF）and survival group（n = 50）matched for age, gender,cardiac function during 30-day hospitalization. Serum levels of Gal-3, NT-proBNP, BNP, CRPand the Minnesota Living with Heart Failure Questionnaire（MLHFQ）were retrospectively collected and compared on the first hospital day and 3 days, 7 days, 14 days after treatment. After 7 days of treatment, the serum levels of four markers were correlated with MLHFQ. The areas under the receiver operating characteristic（ ROC） curve were used for estimating efficiencies of serum levels of four markers in predicting DAACHF patients＇ mortality during 30-day hospitalization. Results With prolonged treatment,the scores of Gal-3, NT-proBNP, BNP, CRP and MLHFQ were gradually increased in the group of death, and gradually decreased in survival group. The scores of Gal-3, NT-proBNP, BNP, CRP and MLHFQ were higher in the death group than in control group（P〈0. 05）at the day of hospital admission and at 3 days, 7 days and 14 days after treatment（P〈0. 05）. On 7 days after treatment,Gal-3, NT-proBNP, BNP, and CRP were positively correlated with MLHFQ score（r= 0. 748,0. 730,0. 6872, all P〈0.01 ）, and the areas under ROC curves predicting performance for mortality during 30-day hospitalization were 0. 943, 0. 907,0. 876,0. 867,0. 913 for Gal-3, NT-proBNP, BNP, CRP and MLHFQ score, respectively, all P 〈. 0. 01）. Conclusions Serum levels of Gab3, NT-proBNP, BNP and CRP were positively correlated with adverse prognosis for DAACHF patients, and they may be predictors of mortality during 30-day hospitalization with sequence effect of Gal-3〉NT-proBNP〉BNP〉CRP. And their joint monitoring is better in predicting the prognosis of patients with heart failure.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2018年第1期19-23,共5页
Chinese Journal of Geriatrics
基金
国家自然科学基金(81070227)
北京市自然科学基金(7142048)
北京市教育委员会科技计划面上项目(km201110025019)
