摘要
目的探讨血清N末端脑钠肽前体(NTpro-BNP)、生长分化因子15(GDF-15)、结缔组织生长因子(CTGF)对射血分数保留的心力衰竭(HFpEF)患者预后的预测价值,为临床构建准确预测其预后的模型提供参考。方法回顾分析2022年1月—2024年9月四川大学华西医院资阳医院收治的317例HFpEF患者的临床资料,患者出院后随访1年,根据患者终点事件分为终点事件组(61例)和无终点事件组(256例)。比较患者血清NT-proBNP、GDF-15、CTGF水平及患者临床资料,分析影响HFpEF患者预后的因素及血清NT-proBNP、GDF-15、CTGF预测HFpEF患者预后的价值。结果终点事件组纽约心脏病协会(NYHA)心功能分级Ⅲ级占比、心肌肌钙蛋白I(cTnI)、C-反应蛋白、NT-proBNP、GDF-15、CTGF水平均高于无终点事件组(均P<0.05)。多因素Logistic回归分析显示,NYHA心功能分级Ⅲ级、NT-proBNP、GDF-15、CTGF是影响HFpEF患者预后的危险因素(P<0.05)。受试者操作特征(ROC)曲线显示,NT-proBNP、GDF-15、CTGF及三者联合预测HFpEF患者预后的灵敏度分别为72.41%、75.86%、62.07%、93.10%,特异度分别为71.09%、77.34%、78.91%、89.84%,曲线下面积(AUC)分别为0.708(95%CI:0.604~0.813)、0.711(95%CI:0.597~0.825)、0.702(95%CI:0.583~0.820)、0.890(95%CI:0.817~0.963),三者联合预测的AUC高于各指标单独预测(Z=2.205、2.373、2.298,均P<0.05)。结论血清NT-proBNP、GDF-15和CTGF是HFpEF患者预后的独立危险因素,据此构建的联合预测模型能提升对HFpEF患者预后的预测效能。
Objective To explore the prognostic value of serum N-terminal pro-brain natriuretic peptide(NTpro-BNP),growth differentiation factor 15(GDF-15),connective tissue growth factor(CTGF)in patients with HFpEF,and to provide a reference for the clinical construction of an accurate model for predicting the prognosis of HFpEF patients.Methods A retrospective analysis was conducted on the clinical data of 317 patients with HFpEF admitted to the West China Hospital Sichuan University-Ziyang Hospital from January 2022 to September 2024.The patients were followed up for one year after discharge and were divided into the endpoint event group(61 cases)and the non-endpoint event group(256 cases)according to the endpoint events.Clinical data such as serum NT-proBNP,GDF-15 and CTGF of patients were collected.The factors influencing the prognosis of patients with HFpEF were analyzed,and the value of serum NT-proBNP,GDF-15 and CTGF in predicting the prognosis of patients with HFpEF was analyzed.Results The proportion of patients with New York Heart Association(NYHA)cardiac function gradeⅢ,the levels of cardiac troponin I(cTnI),C-reactive protein,NT-proBNP,GDF-15,and CTGF in the endpoint event group were all higher than the group without endpoint events(all P<0.05).Logistic regression analysis showed that NYHA cardiac function classification,NT-proBNP,GDF-15 and CTGF were independent factors affecting the prognosis of patients with HFpEF(all P<0.05).ROC curve analysis showed that the sensitivities of NT-proBNP,GDF-15,CTGF and their combination in predicting the prognosis of patients with HFpEF were 72.41%,75.86%,62.07%and 93.10%,and the specificities were 71.09%,77.34%,78.91%and 89.84%,the areas under the curve(AUC)were 0.708(95%CI:0.604-0.813),0.711(95%CI:0.597-0.825),0.702(95%CI:0.583-0.820),and 0.890(95%CI:0.817-0.963).The AUC values obtained from the combined prediction of the three indicators were all higher than the individual indicators(Z=2.205,2.373,and 2.298,all P<0.05).Conclusion Serum NT-proBNP,GDF-15 and CTGF are independent risk factors for the prognosis of patients with HFpEF.A prediction model incorporating these three biomarkers can significantly improve the predictive efficacy for prognosis.
作者
曾令军
田俊才
张婷婷
代青青
魏明莉
ZENG Lingjun;TIAN Juncai;ZHANG Tingting;DAI Qingqing;WEI Mingli(Department of Respiratory and Critical Care Medicine,West China Hospital of Sichuan University-Ziyang Hospital,Ziyang Sichuan 641300,China)
出处
《中国急救复苏与灾害医学杂志》
2026年第4期454-458,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
四川省医学会伤口/慢病(泰阁)专项科研项目(2024TG53)。
关键词
射血分数保留的心力衰竭
N末端脑钠肽前体
生长分化因子15
结缔组织生长因子
预后
Heart failure with preserved ejection fraction
N-terminal pro-brain natriuretic peptide
Growth differentiation factor 15
Connective tissue growth factor
Prognosis
