sTREM-1水平在老年慢性心力衰竭早期诊断及预后评估中的价值

Clinical value of serum sTREM-1 level for early diagnosis and prognostic evaluation in elderly patients with chronic heart failure

目的探讨血清可溶性髓样细胞触发受体(sTREM)-1水平在老年慢性心力衰竭(CHF)早期诊断及预后评估中的价值。方法选取2016年1月至2017年1月就诊的老年CHF患者89例(CHF组)和体检健康的老年志愿者55例(对照组)。采取双抗体夹心酶联免疫吸附法检测血清sTREM-1水平。采用超声心动图检测并计算平均室壁应力(MWS)和左心室心肌质量指数(LVMI)。比较两组血清sTREM-1水平及心功能LVMI、MWS水平。Pearson直线相关分析老年CHF患者sTREM-1水平与LVMI、MWS水平的相关性。CHF组患者随访期失访4例,85例完成随访,出院12个月复查超声心动图,统计心脏事件的发生情况,比较出现心脏事件患者与无心脏事件患者入院时血清sTREM-1水平。采用多因素Logistic回归分析sTREM-1水平与患者心脏事件的关系。结果与对照组比较,CHF组老年患者血清sTREM-1水平[(62.89±7.04)pg/ml vs(20.15±2.58)pg/ml]及MWS[(912.41±92.75)mg vs(771.57±79.05)mg]和LVMI[(2.40±0.26)mg/g vs(1.71±0.21)mg/g]均明显升高,且伴随心功能NYHA分级的增加而明显升高(P<0.01)。CHF组患者血清sTREM-1水平与心功能指标MWS和LVMI分别呈正相关(r=0.651,P<0.01;r=0.681,P<0.01)。出院后第12个月出现心脏事件的老年CHF患者入院时血清sTREM-1水平明显高于无心脏事件患者[(88.75±9.15)pg/ml vs(37.03±4.14)pg/ml,P<0.01]。多因素Logistic回归分析显示,sTREM-1水平是12个月心脏事件的危险因素(OR=7.440,P<0.01)。结论血清sTREM-1可作为老年CHF患者早期诊断和预后判断的预测指标之一。

Objective To explore the value of serum soluble myeloid cell trigger receptor （sTREM）-1 level for early diagnosis and prognostic evaluation in elderly patients with chronic heart failure （CHF）. Methods Eighty-nine elderly CHF patients （CHF group）and 55 healthy elderly volunteers （control group） from January 2016 to January 2017 were selected. Double-antibody sandwich enzyme-linked immunoassay was used to detect serum sTREM-1 level. Echocardiography was used to measure and count the mean ventricular wall stress （ MWS ） and left ventricular mass index （LVMI）. Serum sTREM-1 level and MWS and LVMI values were compared in two groups. Pearson linear correlation analysis was used to analyze the correlation of serum sTREM-1 level with LVMI and MWS in elderly CHF patients. In CHF group,4 cases were missed during follow-up,and 85 cases were followed up for 12 months. Cardiac color echocardiography was re-examined, and the statistics of heart events was made 12 months after discharge. Serum sTREM-1 level at admission was compared in patients with cardiac events and without cardiac events. Multivariate Logistic regression analysis was used to analyze the relationship between sTREM-1 level and cardiac events. Results Compared with control group, serum sTREM-1 level [ （62. 89 ±7.04） pg/ml vs （20. 15 ±2. 58） pg/ml] ,MWS [ （912.41 ±92. 75） mg vs （771.57 ±79. 05） mg ] and LVMI [ （ 2.40 ± 0. 26 ） mg/g vs （ 1.71± 0. 21 ） mg/g ] values increased significantly in CHF group, and their levels rose all with the increase of NYHA classification （ all P 〈 0. 01 ）. Serum sTREM-1 level was positively correlated with cardiac function indexes MWS and LVMI in elderly CHF patients （P 〈 0. 01 ）. Serum sTREM-1 level at admission in elderly CHF patients with cardiac events 12 months after discharge was significantly higher than that in patients without cardiac events [ （ 88.75 ± 9. 15 ） pg/ml vs （ 37.03 ± 4. 14 ） pg/ml, P 〈 0. 01 ]. Muhivariate logistic regression analysis showed that sTREM-1 level was a risk factor of 12-month cardiac events （OR = 7. 440, P 〈 0. 01 ）. Conclusion Serum sTREM-1 level can be served as one of the predictive indexes of early diagnosis and prognostic evaluation in elderly CHF patients.