摘要
目的本研究旨在探讨血清半胱氨酸蛋白酶抑制剂C(CysC)水平与慢性心力衰竭(CHF)患者低T3综合征(LT3S)之间的关系,并评估患者健康问卷-9(PHQ-9)得分在这一关系中的中介作用。方法本研究纳入2022年9月至2024年1月期间于陕西省汉中市中心医院心内科住院的CHF患者。采用logistic回归分析方法评估CysC与LT3S之间的关系。同时,使用SPSS中的Process插件评估PHQ-9得分的中介效应。结果本研究共纳入503例CHF患者,年龄为(65.17±10.12)岁,有170例(占33.8%)患者被诊断为LT3S,其余333例患者未被诊断为LT3S。两组患者在性别构成、年龄、高血压和糖尿病等合并症比例的差异无统计学意义(P均>0.05)。LT3S组患者的B型利钠肽(BNP)、血尿素、血尿酸、血肌酐、CysC、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)及PHQ-9评分高于无LT3S组患者,差异有统计学意义(P均<0.05)。相关分析结果显示,游离三碘甲腺原氨酸(FT3)与PHQ-9得分呈显著负相关(r=-0.396,P<0.001),FT3与CysC也呈显著负相关(r=-0.278,P<0.001),而PHQ-9得分与CysC呈正相关(r=0.217,P<0.001)。根据CysC的四分位数(Q1∶0.49~0.99 mg/L,Q2∶1.00~1.20 mg/L,Q3∶1.21~1.55 mg/L,Q4∶1.56~5.16 mg/L),多因素logistic回归分析结果显示,与Q1组相比,Q2、Q3和Q4组LT3S的风险显著增加,比值比(OR)及95%可信区间(CI)分别为3.88(1.98~7.60)、4.42(2.19~8.93)和5.55(2.49~12.38)(P均<0.001)。CysC每升高1 mg/L,LT3S的风险增加1.82倍,OR(95%CI)为2.82(1.68~4.72,P<0.001)。受试者工作特征(ROC)分析确定了CysC诊断LT3S的阈值为1.16 mg/L,敏感性为70%,特异性为55%,曲线下面积(AUC)及95%CI为0.645(0.594~0.695,P<0.001)。中介分析结果显示,CysC对LT3S有直接效应(效应=0.677,P=0.009),95%CI为(0.168~1.186),CysC通过PHQ-9对LT3S有间接效应(效应=0.373),95%CI为(0.17~0.68)。结论CysC是CHF患者中LT3S的重要临床预测因子,抑郁症状在这一关系中起到中介作用。这些发现为CHF患者的临床筛查和干预提供了新的见解。
ObjectivesTo investigate the relationship between serum cystatin C(CysC)and low T3 syndrome(LT3S)in patients with chronic heart failure(CHF),and to assess the mediating role of Patient Health Questionnaire-9(PHQ-9)score in this association.MethodsPatients hospitalized from September 2022 to January 2024 in the Department of Cardiology,Hanzhong Central Hospital of Shaanxi Province were enrolled.Logistic regression analysis was conducted to evaluate the relationship between CysC and LT3S.Additionally,the mediating effect of PHQ-9 score was assessed using the Process plugin in SPSS.ResultsA total of 503 patients with CHF were enrolled with the age of(65.17±10.12)years,of whom 170 patients(33.8%)were diagnosed with LT3S and other 333 patients were not.No statistically significant differences were found in gender,age,or comorbidities such as hypertension and diabetes between the two groups(all P>0.05).However,levels of B-type natriuretic peptide(BNP),blood urea,uric acid,creatinine,CysC,alanine aminotransferase(ALT),aspartate aminotransferase(AST),and PHQ-9 score were significantly higher in the LT3S group than those without LT3S(all P<0.05).Correlation analysis revealed a significant negative correlation between free triiodothyronine(FT3)and PHQ-9 score(r=-0.396,P<0.001)and between FT3 and CysC(r=-0.278,P<0.001),whereas PHQ-9 score showed a positive correlation with CysC(r=0.217,P<0.001).Based on the quartiles of CysC level(Q1:0.49-0.99 mg/L,Q2:1.00-1.20 mg/L,Q3:1.21-1.55 mg/L,Q4:1.56-5.16 mg/L),multivariate logistic regression showed that compared to Q1,the risk of LT3S significantly increased in Q2,Q3,and Q4,with odds ratio(OR)and 95%confidence interval(CI)of 3.88(1.98-7.60),4.42(2.19-8.93),and 5.552(2.49-12.38)for Q2,Q3,and Q4,respectively(all P<0.001).Moreover,for each 1 mg/L increase in CysC,the risk of LT3S increased 1.82 times with the OR(95%CI)of 2.82(1.68-4.72,P<0.001).Receiver operating characteristic(ROC)curve analysis established a diagnostic threshold of CysC for LT3S at 1.16 mg/L,with a sensitivity of 70%,specificity of 55%,and the area under the curve(AUC)with 95%CI of 0.645(0.594-0.695,P<0.001).The mediation analysis showed a significant direct effect of CysC on LT3S(effect=0.677,P=0.009)with 95%CI of(0.168-1.186),and a significant indirect effect through PHQ-9 on LT3S(effect=0.373)with 95%CI of(0.173-0.686).ConclusionCysC is an important clinical predictor of LT3S in patients with CHF,and depressive symptoms mediate this relationship.These findings offer new insights for clinical screening and intervention in CHF patients.
作者
王露朝
马妮娜
王娜
王励敏
Wang Luchao;Ma Nina;Wang Na;Wang Limin(Department of Cardiology,Hanzhong Central Hospital of Shaanxi Province,Hanzhong 723011,China)
基金
陕西省重点研发计划项目(2024SF-YBXM-012)
汉中市中心医院研究资金项目(YK2443)。
