摘要
目的探讨可溶性ST2(sST2)及Tilburg衰弱量表(TFI)对老年慢性心力衰竭(CHF)患者预后的评估价值。方法选取2017年1月至2018年6月心内科收治的经确诊为老年CHF患者248例作为研究对象,根据NYHA心功能分级将患者分为4组,比较4组sST2及TFI评分水平。再根据患者随访期间是否发生不良心血管事件(major adverse cardiovascular events,MACE)分为MACE组(n=96)和非MACE组(n=152),收集患者一般临床资料、入院第2天血液生化指标、sST2及TFI评分,COX比例风险模型分析,sST2及TFI评分与MACE的关系,并根据ROC曲线下sST2及TFI评分的最佳临界值对老年CHF患者进行危险分组,经Kaplan-Meier生存分析法分析各组间MACE平均发生时间的差异。结果sST2及TFI评分水平随NYHA心功能分级的增高呈明显上升,差异有统计学意义(P<0.05);与非MACE组比较,MACE组患者sST2及TFI评分更高,差异均有统计学意义(P<0.05);sST2及TFI评分的ROC曲线下面积分别为0.722、0.761,具有较高的诊断价值,最佳临界值分别为105.36 ng/ml、8分;COX分析结果显示,sST2>105.36 ng/ml、TFI评分>8分是老年CHF患者发生MACE的独立危险因素;以sST2及TFI评分的最佳临界值将患者分层,高危组生存率明显低于低危组和中危组(χ^2=6.384,P=0.024;χ^2=8.384,P=0.002)。结论老年CHF患者sST2、TFI评分随着心功能增加明显升高,同时二者是老年CHF患者发生MACE的独立预测因子,且诊断价值较高,二者联用可提高老年CHF患者1年MACE发生的预测效率,具有潜在临床诊断价值。
Objective To investigate the assessment value of soluble ST2(sST2)combined with Tilburg feeble scale(TFI)in evaluating the prognosis of elderly patients with chronic heart failure(CHF).Methods A total of 248 elderly patients with CHF who were admitted and treated in our hospital from January 2017 to June 2018 were enrolled as research objects,who were were divided into four groups according to NYHA cardiac function classification,and the sST2 and TFI scores were observed and compared among the four groups.According to whether they had Major adverse cardiovascular events(MACE)during follow up,who were divided into MACE group(n=96)and non-mace group(n=152).The general clinical data,blood biochemical indicators on the second day of admission,sST2 and TFI scores were oserved.In addition the COX proportional risk model was used to analyze the correlation between sST2 as well as TFI scores and MACE,and thepatients with CHF were divided in to different risk groups according to the optimal critical value of sST2 and TFI scores under ROC curve.Kaplan-meier survival analysis was used to analyze the differences in the average occurrence time of MACE among the groups.Results The sST2 and TFI scores were significantly increased with the increase of NYHA cardiac function grading(P<0.05).As compared with those in non-MACE group,the sST2 and TFI scores in MACE group were significantly increased(P<0.05).The area under the ROC curve of sST2 and TFI scores were 0.722 and 0.761,respectively,with higher diagnostic value,and the optimal critical value was 105.36ng/ml and 8 points,respectively.COX analysis results showed that sST2>105.36ng/ml and TFI score>8 were independent risk factors of MACE in elderly patients with CHF.The survival rate in high-risk group was significantly lower than that in low-risk group and medium-risk group(P<0.05).Conclusion The sST2 and TFI scores in elderly patients with CHF are significantly increased with the increase of cardiac function,and both of them were the independent predictors of incidence of MACE in elderly patients with CHF,with higher diagnostic value.Moreover the combined use of the two indexes can improve the prediction efficiency for the incidence of MACE in elderly patients with CHF within 1 years,which has potential clinical diagnostic value.
作者
孟影
周炳凤
付敏敏
高斐
MENG Ying;ZHOU Bingfeng;FU Minmin(Department of Cardiology,Binhu Hospital of Hefei City,Anhui Hefei 230000,China)
出处
《河北医药》
CAS
2020年第22期3388-3391,3396,共5页
Hebei Medical Journal
