老年慢性心力衰竭患者血浆心肌营养素-1的检测及临床意义

Plasma level of cardiotrophin-1 as a prognostic predictor in elderly patients with chronic heart failure

目的:探讨血浆心肌营养素-1(CT-1)在老年慢性心力衰竭(CHF)患者中的作用和临床意义。方法:应用酶联免疫吸附测定法(ELISA)测定21例老年健康人(对照组)、69例老年CHF患者(CHF组,NYHAⅡ级22例,Ⅲ级27例,Ⅳ级20例)血浆CT-1、脑钠素(BNP)水平,同时采用超声心动图测定左室射血分数(LVEF)评定患者心功能。结果:CHF组血浆CT-1、BNP水平与对照组比较明显升高,差异具有统计学意义(t=5.824,P<0.01;t=6.062,P<0.01)。CHF组组间比较,各组CT-1水平差异均具有统计学意义(F=52.607,P<0.01),NYHAⅣ级组CT-1水平明显高于NYHAⅢ级组、NYHAⅡ级(P<0.05或P<0.01),NYHAⅢ级组明显高于NYHAⅡ级(P<0.05)。直线相关分析显示,CHF组血浆CT-1与BNP、心功能分级呈正相关(r=0.753,P<0.01或r=0.523,P<0.01),与LVEF呈负相关(r=-0.581,P<0.01)。通过绘制CT-1的ROC曲线,CT-1在ROC曲线下的面积为0.92,95%的可信区间为0.864～0.976,曲线下面积差异有统计学意义(P<0.01)。结论:老年CHF患者血浆CT-1水平明显升高,且与BNP、NYHA分级、LVEF具有较好的相关性。联合检测老年CHF患者血浆CT-1、BNP水平有助于CHF诊断及判断预后。

Objective：To evaluate the role of plasma level of cardiotrophin-1 （CT-1） in elderly patients with chronic heart failure（CHF）. Method：We measured the plasma levels of CT-1 and brain natriuretic peptide （BNP） in 69 patients with CHF and 21 normal controls by enzyme-linked immunosorbent assay （ELISA）. Meanwhile, the cardiac function were accessed by NYHA standard and echocardiogram. Result：Plasma levels of CT-1 and BNP in patients with CHF were apparently higher than those of normal controls, the difference between these two groups was significant in statistics（P〈0.01）. With the increase in NYHA and progress of disease, the plasma levels of CT-1 and BNP significantly increased. Plasma levels of CT 1 and BNP in different NYHA had statistical significance（P〈0.01 or P〈0.05）. There were significant correlation among plasma CT-1 and BNP and NYHA. Reversely, there was a significant negative correlation between plasma CT-1 and left ventricular ejection fraction. By plotting the ROC curve, the area under the curve （AUC） is 0.92（95%CI： 0. 864-0. 976, P〈0.01）. Conclusion：The plasma level of CT-1 increased with severity of CHF. There were good correlation among CT 1,BNP, NYHA and LVEF. Combined investigation of CT-1 and BNP will help to predict additional diagnostic and prog nostic information for elderly patients with chronic heart failure.