摘要
目的 研究血清半乳糖凝集素-3(Gal-3)、高敏心肌肌钙蛋白T(hs-cTnT)、C1q肿瘤坏死因子相关蛋白3(CTRP3)联合应用对老年心力衰竭(HF)并发心房颤动患者的预后评估,探讨相关指标对患者的预后价值。方法 选取老年慢性HF患者208例,根据是否并发心房颤动(AF)分为HF合并AF组和HF组,另选取同期健康对照组80例。收集整理入组对象的临床资料;检测血清Gal-3、hs-cTnT和CTRP3;随访HF合并AF组患者的再次HF和心律失常、心源性死亡事件。Cox回归分析HF合并AF组预后的影响因素;ROC曲线分析血清Gal-3、hs-cTnT和CTRP3的诊断价值和预后评估价值。结果 HF组、HF合并AF组血清N末端脑钠肽前体(NT-proBNP)、Gal-3、hs-cTnT和左房内径(LAD)高于健康对照组,左室射血分数(LVEF)和CTRP3低于健康对照组(P<0.05);HF合并AF组血清NT-proBNP、Gal-3、hs-cTnT高于HF组,CTRP3低于HF组(P<0.05)。预后不良组患者心功能Ⅳ级比例高于预后良好组,NT-proBNP、LAD、Gal-3、hs-cTnT水平高于预后良好组,LVEF、CTRP3低于预后良好组(P<0.05)。NT-proBNP(HR=2.053)、Gal-3(HR=3.022)、hs-cTnT(HR=3.165)是HF合并AF组患者预后不良的危险因素,LVEF(HR=0.126)、CTRP3(HR=0.433)是保护因素(P<0.05)。联合检测血清Gal-3、hs-cTnT、CTRP3预测HF合并AF组患者预后不良的价值(AUC=0.903)高于单独检测(AUC=0.797、AUC=0.767、AUC=0.796)(Z_(联合-Gal-3)=2.244、Z_(联合-hs-cTnT)=2.654、Z_(联合-CTRP3)=2.409)(P<0.05)。结论 老年HF并发AF患者血清Gal-3、hs-cTnT水平较高,CTRP3水平较低,相较于预后良好患者,预后不良患者血清Gal-3、hs-cTnT水平更高,CTRP3水平更低,联合检测血清Gal-3、hs-cTnT、CTRP3可用于评估和预测患者的预后。
Objective To investigate the combined application of serum galectin-3(Gal-3),high-sensitivity cardiac troponin T(hs-cTnT),and C1q tumor necrosis factor-related protein 3(CTRP3)for the prognostic evaluation of elderly heart failure(HF)patients with arrhythmias.Methods A total of 208 elderly patients with chronic HF were selected and divided into two groups:HF with atrial fibrillation(AF)group and HF group.A healthy control group of 80 individuals was also included.Clinical data were collected,and serum levels of Gal-3,hs-cTnT,and CTRP3 were measured.Follow-up was conducted to observe events of recurrent HF,arrhythmias,and cardiovascular death in the HF with AF group.Cox regression analysis was used to identify factors affecting prognosis in the HF with AF group.Receiver operating characteristic(ROC)curve analysis was used to evaluate the diagnostic and prognostic value of serum Gal-3,hs-cTnT,and CTRP3.Results In comparison with the healthy control group,NT-proBNP,Gal-3,hs-cTnT,and left atrial diameter(LAD)were higher,while left ventricular ejection fraction(LVEF)and CTRP3 were lower in both HF and HF with AF groups(P<0.05).In the HF with AF group,NT-proBNP,Gal-3,and hs-cTnT were higher,while CTRP3 was lower compared to the HF group(P<0.05).In the poor prognosis group,the proportion of patients with NYHA functional classⅣwas higher,and NT-proBNP,LAD,Gal-3,and hs-cTnT levels were higher,while LVEF and CTRP3 were lower compared to the good prognosis group(P<0.05).NT-proBNP(HR=2.053),Gal-3(HR=3.022),and hs-cTnT(HR=3.165)were identified as risk factors for poor prognosis in the HF with AF group,while LVEF(HR=0.126)and CTRP3(HR=0.433)were protective factors(P<0.05).The combined detection of serum Gal-3,hs-cTnT,and CTRP3 had a higher prognostic value for poor outcomes in the HF with AF group(AUC=0.903)compared to individual tests(AUC=0.797,AUC=0.767,AUC=0.796)(ZGal-3=2.244,Zhs-cTnT=2.654,ZCTRP3=2.409,P<0.05).Conclusion In elderly HF patients with arrhythmias,serum Gal-3 and hs-cTnT levels are elevated,while CTRP3 levels are reduced.Compared with those with good prognosis,patients with poor prognosis have higher levels of Gal-3 and hs-cTnT and lower CTRP3 levels.The combined detection of serum Gal-3,hs-cTnT,and CTRP3 can be used for prognostic evaluation and prediction in these patients.
作者
卢厚新
刘嘉
韩克丽
李新果
LU Hou-xin;LIU Jia;HAN Ke-li;LI Xin-guo(Ward 2,Department of Cardiovascular Medicine,Nanyang Central Hospital,Nanyang 473000,Henan,China)
出处
《广东医学》
2025年第4期532-537,共6页
Guangdong Medical Journal
基金
河南省医学科技攻关计划(联合共建)项目(LHGJ202201037)。
