正五聚蛋白-3水平对慢性心力衰竭患者预后的价值研究

Pentraxin-3 predicts long-term prognosis of patients with chronic heart failure

目的探讨血浆正五聚蛋白-3（PTX3）水平对慢性心力衰竭患者预后的预测价值。方法检测406例慢性心力衰竭患者入院后次日早晨血PTX3水平并前瞻性随访2年，观察全因死亡、心力衰竭再次住院、急性心肌梗死、卒中及周围动脉栓塞，分析PTX3水平与心血管事件的关系。结果共有376例患者完成随访，171例患者发生心血管事件。心血管事件组PTX3水平较无心血管事件组显著增高[（3.911＆#177;0.83）ng/ml vs（3.088＆#177;0.99）ng/ml，P＜0.01]；PTX3浓度与慢性心力衰竭严重程度呈正相关（P＜0.01），PTX3浓度增高（≥中位数3.438ng/ml）组患者出现心血管事件明显增加（63.5%vs 27.3%，P＜0.01），生存函数Kaplan-Meier曲线也显示PTX3≥3.438ng/ml患者无心血管事件生存率明显降低（P＜0.01），多因素逐步分析显示PTX3浓度增高是慢性心力衰竭患者出现心血管事件的独立危险因子（RR=4.224，P＜0.01；95%CI 1.130～15.783）。结论 PTX3浓度增高的慢性心力衰竭患者发生心血管事件风险显著增加，PTX3浓度增高可能是慢性心力衰竭患者预后的独立预测因子。

Objective To evaluate the prognostic value of plasma PTX3 in patients with chronic heart failure（CHF）. Methods A total of 406 consecutive patients with CHF were prospectively enrol ed in this study and fol owed up for 2 years. Plasma PTX3 level was measured in the second morning after hospitalization. Al-caused death, re-hospitalization for heart failure, acute myocardial infarction, stoke and peripheral arterial embolism were documented. The relationship between plasma PTX3 and cardiovascular events （CVE） were analyzed. Results 376 patients had been fol owed up for 2 years, of them, 171 patients experienced CVE. Plasma PTX3 level was significantly higher in patients with than without CVE （3.911＆#177;0.83ng/ml vs 3.088＆#177;0.99ng/ml, P〈0.01） and positively related to the severity of heart failure （P〈0.01）. CVE were more frequency in patients with increased PTX3 （≥median value 3.438ng/ml） than those without（63.5%vs 27.3%, P＆lt;0.01）. Kaplan-Meier analysis revealed that patients with increased PTX3（≥3.438ng /ml） had a significantly lower survival rate without CVE （P〈0.01）. Multi-factor analysis showed that increased PTX3 was an independent risk factor for CVE in patients with CHF （RR=4.224, P〈0.01;95%CI 1.130-15.783）. Conclusion CHF patients with increased PTX3 have a higher risk of developing CVE. Increased PTX3 may be an independent predictor for prognosis of patients with CHF.