半乳糖凝集素-3评价老年急性心力衰竭患者病情与预后的研究

The predicting value of serum Galectin-3 on prognosis in elderly patients with acute heart failure

目的:观察与讨论血清半乳糖凝集素-3(Gal-3)浓度在老年急性心力衰竭(AHF)患者病情严重程度以及预后评估中的价值。方法:选取AHF患者共72例,并以年龄、性别相匹配的42例健康体检人员为对照,采用酶联免疫吸附法(ELISA)检测血清Gal-3,同时收集患者临床资料,并随访所有病例90d,记录生存与否或再次因心衰入院。临床资料应用SPSS 21.0软件进行统计处理计量资料采取t检验,计数资料采取χ2检验,对生存状况进行Logistic二元回归分析及受试者工作曲线(ROC curve)分析。结果:AHF患者的Gal-3浓度(ng/mL)较正常对照组有显著升高[(19.92±9.35)vs.(6.75±1.58),P<0.05],并与N-末端脑钠肽前体(NT-proBNP)呈正相关(r=0.574,P<0.01);Gal-3水平在不同心功能临床分级(轻症组、重症组)中比较均差异有统计学意义[(13.75±8.13)vs.(25.14±6.84),P<0.05]。在72例AHF患者中,发生终点不良事件患者Gal-3明显高于无不良事件患者[(24.67±8.02)vs.(14.89±8.01),P<0.05]。独立危险因素非条件Logistic二元回归模型分析,NT-proBNP和Gal-3对不良预后有独立预测意义,OR值分别为1.001和1.096;以Gal-3血清浓度17.21ng/mL为cutoff值评估不良预后,其敏感性为81.08%、特异性为74.29%、阳性预测值为76.90%、阴性预测值为78.80%和准确率为77.78%,若联合NT-proBNP评估其效果更优,ROC曲线下面积为0.842。结论:Gal-3在老年AHF患者入院早期即有显著升高,并且随心功能临床分级而相应升高,提示血清Gal-3可评价AHF病情严重程度;发生心血管不良事件的AHF患者的Gal-3水平明显高于无不良事件发生者,表明血清Gal-3可以评估AHF患者的预后;若结合NT-proBNP,则可以更好地进行危险分层和预后评估。

Objective:To investigate the predicting value of serum galectin-3(Gal-3)on risk stratification and prognosis in elderly patients with acute heart failure(AHF).Method:Total of 72 AHF patients aged 65 to 93 were selected in our study who were in Beijing Hospital during 2017-09-2018-01 including 38 cases of male and 34 cases of female.Moreover,42 healthy people aged 65 to 87 were chosen as control group,which contains 25 cases of male and 17 cases of female.Serum galectin-3 was detected by ELISA.Follow-up was performed 90 days after acute attack.The end point composes of all-cause mortality and AHF re-hospitalization.The data was analyzed by SPSS21.0.Result:Compared with control group,serum Gal-3 level(ng/mL)was significantly elevated in AHF group[(19.92±9.35)vs.(6.75±1.58),P<0.05].No significant difference was found between male and female[(20.07±9.51)vs.(19.74±9.32),P>0.05].Gal-3 level was significantly different between patients with different clinical heart function grade[(13.75±8.13)(mild-Warm & Dry and Warm & Wet)vs.(25.14±6.84)(severeCold & Dry and Cold & Wet),P<0.05].Among the 72 AHF patients Gal-3 levels were increased in patients with higher NT-proBNP levels(r=0.574,P=0.000),Gal-3 level was higher in patients with endpoint events than those without endpoint events[(24.67±8.02)vs.(14.89±8.01),P<0.05].According to the independent risk factors of unconditioned Logistic bivariate regression model analysis the levels of NT-proBNP and Gal-3 had independent predicting value of AHF,and the ORvalue were 1.001 and 1.096 respective.We found that the cutoff value of Gal-3(17.21 ng/mL)may be a valuable evaluation marker of prognosis,the sensitivity and specificity was81.08% and 74.29%,and the positive and negative predictive rate were 76.90% and 78.80%.The accuracy rate was 77.78%.Combined with NT-proBNP to predict the prognosis of AHF,the result would be more exciting.The area under the ROC curve is 0.842.The endpoint event rate of the patients whose level of Gal-3 was below17.21 ng/mL and NT-proBNP level below 13461 pg/mL was 19.35%,while the data in patients whose level of Gal-3 is above 17.21 ng/mL and NT-proBNP above 13461 pg/mL was 95.45%.Conclusion:Early at admission of AHF in elderly patients Gal-3 began to elevate markedly related with the extent of heart failure.The result shows that the level of Gal-3 may be used to evaluate patient.The elevation of Gal-3 has independent predictive value to the prognosis of AHF.It will be better to predict the prognosis combining Gal-3 with other biomarkers such as NTproBNP.