血清尿酸、胱抑素C、NT-pro-BNP及PCT表达水平与CHF并发医院感染患者预后的关系

Analysis of relationship between expression levels of serum uric acid,cystatin C,NT-pro-BNP and PCT and prognosis of patients with chronic heart failure complicated with nosocomial infection

目的探讨血清尿酸、胱抑素C(Cys C)、N末端B型利钠肽前体(NT-pro-BNP)及降钙素原(PCT)表达水平与慢性心力衰竭(CHF)并发医院感染患者预后的关系。方法回顾性分析2017年1月-2019年2月东方医院收治的224例CHF住院患者,其中并发医院感染患者110例(感染组),单纯慢性心力衰竭患者114例(未感染组),采用酶联免疫吸附法检测血清尿酸、PCT、NT-pro-BNP、Cys C,住院期间及出院后3个月内发生不良心脏事件(MACE)为预后不良,分析影响CHF并发医院感染患者预后的危险因素,应用受试者工作特征曲线(ROC)和曲线下面积(AUC)分析尿酸、Cys C、NT-pro-BNP、PCT单独检测和四项联合对CHF并发医院感染患者预后的预测价值。结果感染组CHF患者血清尿酸、Cys C、NT-pro-BNP、PCT均显著高于未感染组,差异有统计学意义(P<0.05)。感染组预后不良率为38.18%(42/110),显著高于未感染组的20.18%(23/114),差异有统计学意义(P<0.05)。感染组预后不良者血清尿酸、Cys C、NT-pro-BNP、PCT均显著高于预后良好者,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,美国纽约心脏协会(NYHA)分级、尿酸、Cys C、NT-pro-BNP、PCT是影响CHF并发医院感染患者预后独立危险因素(P<0.05)。四项联合预测CHF并发医院感染患者预后的AUC大于单独检测及两项联合检测。结论血清尿酸、Cys C、NT-pro-BNP、PCT可用于CHF并发医院感染患者的预后评估,四项联合检测的预测效能更优。

Objective To investigate the relationship between expression levels of serum uric acid,cystatin C(Cys C),Nterminal pro-brain natriuretic peptide(NT-pro-BNP)and procalcitonin(PCT)and prognosis of patients with chronic heart failure(CHF)complicated with nosocomial infection.Methods A retrospective analysis was performed on 224 inpatients with CHF admitted from January 2017 to February 2019,including 110 patients complicated with nosocomial infection(infected group)and 114 patients with simple chronic heart failure(uninfected group).The levels of serum uric acid,PCT,NT-pro-BNP and Cys C were detected by enzyme linked immunosorbent assay.The occurrence of major adverse cardiac events(MACE)during hospitalization and within 3 months after discharge was set as poor prognosis.The risk factors that affected prognosis of patients with CHF complicated with nosocomial infection were analyzed.The receiver operating characteristic curve(ROC)and the area under the curve(AUC)were used to analyze the predictive value of uric acid,Cys C,NT-pro-BNP,and PCT and combination of the four on the prognosis of patients with CHF complicated with nosocomial infection.Results The levels of serum uric acid,Cys C,NT-pro-BNP and PCT in infected group were significantly higher than those in uninfected group(P<0.05).The poor prognosis rate in infected group was significantly higher than that in uninfected group[38.18%(42/110)vs.20.18%(23/114)](P<0.05).The levels of serum uric acid,Cys C,NT-pro-BNP and PCT of patients with poor prognosis in infected group were significantly higher than those in patients with good prognosis(P<0.05).Multivariate Logistic regression analysis showed that New York heart association(NYHA)classification,uric acid,Cys C,NT-pro-BNP and PCT were independent risk factors affecting the prognosis of patients with CHF complicated with nosocomial infection(P<0.05).The AUC of combination of the four was greater than those of separate detection or two combined detection in predicting the prognosis of patients with CHF complicated with nosocomial infection.Conclusions Serum uric acid,Cys C,NT-pro-BNP and PCT could be used to evaluate the prognosis of patients with CHF complicated with nosocomial infection.The combination of the four had better predictive efficacy.