心肌营养素-1在舒张性心力衰竭中的检测意义

Serum level of cardiotrophin-1 as a prognostic predictor in diastolic heart failure

目的:探讨血浆心肌营养素-1(CT-1)在舒张性心力衰竭(DHF)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31例非DHF患者(对照组),DHF患者91例,纽约心脏病协会心脏分级(NYHA)Ⅱ级30例,Ⅲ级31例,Ⅳ级30例的血清CT-1、脑钠素(BNP)水平。结果:DHF组血清CT-1、BNP水平与对照组比较明显升高,差异有统计学意义(P<0.05)。DHF组组间比较,各组CT-1水平差异均有统计学意义(P<0.05),NYHAⅣ级组CT-1水平明显高于NYHAⅢ级组和NYHAⅡ级组(P<0.05),NYHAⅢ级组明显高于NYHAⅡ级组(P<0.05)。直线相关分析显示,DHF组血清CT-1水平与BNP呈正相关(r=0.619,P<0.05)。通过绘制CT-1的ROC曲线,CT-1在ROC曲线下的面积为0.923,95%的可信区间为0.878～0.968,曲线下面积差异有统计学意义(P<0.05)。结论:CT-1可能是DHF诊断和预后判断的较好实验室指标。CT-1和BNP联合检测有助于提高DHF诊断及预后判断的准确性。

Background：Cardiotrophin-1（CT-1） is a member of the interleukin（IL-6） family of cytokines and is increased in patients with chronic heart failure（CHF）.However,it is unknown whether CT-1 is characterized by increased in diastolic heart failure.Objective：To evaluate the meaning of cardiortrophin-1 in serum as an indication of diagnosis and prognosis and the relation with brain natriuretic peptide during diastolic heart failure through examining cardiortrophin-1 level in serum.Methods：Total 91 cases were classified three groups according to the cardiac function（NYHA standard）.The cardiac function Ⅱ degree A group was 30 cases;the cardiac function Ⅲ degree B group was 31 cases;the cardiac function Ⅳ degree C group was 30 cases.at the same time,31 cases non-heart failure were examined as control group D group.All groups were examined serum cardiortrophin-1 and brain natriuretic peptide by enzyme-linked immunosorbent assay（ELISA） when all patients were on an empty stomach on the same day.Results：the cardiotrophin-1 and brain natriuretic peptide of the heart failure groups were much higher than control group.there was significant statistical difference between A B C group and D group（P 0.05）.Furtheremore,there was significant statistical difference between A group and B group,B group and C group,A group and C group.the cardiortrophin-1 was positive relation with brain natriuretic between A B C group and D group.By plotting the ROC curve,the area under the curve（AUC） is 0.923（95 % CI：0.878 ～ 0.968,P 0.05）.Conclusion：The cardiotrophin-1 in serum was an better indicator to diagnose and evaluate prognosis of the patient of diastolic heart failure.Combined investigation of CT-1 and BNP will help to predict additional diagnostic and prognostic information for the patient of diastolic heart failure.