心脏彩超联合胱抑素C对慢性心力衰竭患者3年预后的评估价值

Color Doppler echocardiography combined with serum Cystatin C level in evaluation of prognosis in patients with chronic heart failure

目的研究心脏彩超指标左心室射血分数(LVEF)、左心房内径(LAD)、左心室内径(LVD)联合胱抑素C(CysC)对慢性心力衰竭(CHF)患者3年预后的评估价值。方法收集心内科收治的149例CHF患者,根据患者预后情况分为存活组113例,死亡组36例,记录患者一般情况及心脏彩超数据,抽取静脉血,检测血清中CysC的含量。随访3年,终点事件为心源性死亡。多因素logistic回归分析影响CHF患者3年病死率的危险因素,ROC曲线分析LVEF、LAD、LVD和CysC对预测CHF患者3年病死率的价值,并进一步评价心脏彩超指标与CysC联合检测对评估CHF患者3年预后的价值。结果死亡组患者的年龄、BMI、SBP、LAD、LVD、BNP、CysC、Cr均高于存活组患者(均P<0.05),LVEF低于存活组患者(P<0.05)。多因素log is tic回归分析显示:LVEF(OR=0.79,95%CI:0.72~0.95,P=0.002)是影响CHF预后的保护因素,LAD(OR=1.32,95%CI:1.17~1.45,P=0.003),LVD(OR=1.31,95%CI:1.11~1.53,P=0.001),CysC(OR=2.04,95%CI=1.03~5.07,P=0.023),Cr(OR=1.27,95%CI:1.12~1.24,P=0.018)均是影响CHF预后的独立危险因子。ROC曲线分析显示LVEF、LAD、LVD和CysC AUC分别为0.742(95%CI:0.664~0.810)、0.766(95%CI:0.689~0.831)、0.740(95%CI:0.662~0.809)以及0.768(95%CI:0.692~0.833)。LVEF、LAD、LVD和CysC 4者联合检测的AUC为0.864(95%CI:0.798~0.914),优于单一检测LVEF、LAD、LVD或者CysC(P<0.01)。结论 LVEF是影响CHF患者预后的保护因素,而LAD、LVD和CysC是影响CHF患者预后的独立危险因素。心脏彩超联合CysC可以更准确地判断CHF患者的预后。

Objective To assess the application of color Doppler echocardiography combined with Cystain C (CysC) levelin evaluation of prognosis in patients with chronic heart failure (CHF). Methods One hundred and forty nine CHF patientsadmitted in our hospitals were enrolled in the study. Color Doppler echocardiography was performed and serum CysC levels werealso measured in all patients. Patients were followed- up for 3 years, and the end point was cardiogenic death. MultivariateLogistic regression analysis was used to estimate the risk factors for 3- year mortality in patients with CHF, and ROC was used toanalyze the prognostic value of echocardiography parameters left ventricular ejection fraction(LVEF), left atrial diameter (LAD), leftventricular diameter (LVD) and CysC level in CHF patients. Results Thirty- six patients died of cardiovascular events during thefollow- up period, accounting for 24.16%. Multivariate Logistic regression analysis showed that LVEF(OR=0.79, 95%CI:0.72- 0.95,P=0.002) , LAD(OR=1.32, 95%CI:1.17- 1.45, P=0.003), CysC(OR=2.04, 95%CI:1.03- 5.07, P=0.023) and creatinine (OR=1.27, 95%CI:1.12- 1.24, ) were independently associated with the prognosis of patients. ROC curve analysis showed the areas under curve(AUC) of LVEF, LAD, LVD and CysC were 0.742(95%CI:0.664- 0.810), 0.766(95%CI:0.689- 0.831), 0.740(95%CI:0.662- 0.809) and0.768(95%CI:0.692- 0.833), respectively. The AUC value of LVEF & LAD & LVD & CysC [0.864(95%CI:0.798- 0.914)] was higher than that of a single indicator, (P<0.001). Conclusion The parameters of echocardiography LVEF, LAD, LVD and serum CystatinC level are associated with the prognosis of CHF patients. The prognostic value would be increased when these parameters areused in combination.