慢性心力衰竭患者血清SIRT1水平变化及其对预后评估的价值

Change in levels of serum SIRT1 in patients with chronic heart failure and its value in prognosis evaluation

目的探讨沉默信息调节因子2相关酶1(SIRT1)预测慢性心力衰竭(CHF)患者预后的价值。方法选择CHF患者136例(CHF组)、体检健康者50例(对照组),入组24 h内采集肘静脉血,采用ELISA法检测血清SIRT1、N末端B型钠尿肽原(NT-pro BNP);采用Vivid7彩色多普勒超声诊断仪,以美国超声心动图学会推荐的标准测量左心室舒张末期内径(LVEDD),以改良Simpson法测量左心室射血分数(LVEF)。对所有CHF患者进行为期2年随访,记录随访期内死亡情况。采用受试者工作特征(ROC)曲线分析血清SIRT1预测CHF患者预后的价值。结果与对照组比较,CHF组血清SIRT1水平明显降低,且血清SIRT1水平随CHF患者NYHA心功能分级升高而逐渐降低(P均<0.05)。Spearman相关分析显示,血清SIRT1水平与血清NT-pro BNP水平及LVEDD呈负相关关系,与LVEF呈正相关关系(P均<0.05)。随访2年,CHF患者因心血管原因死亡45例。死亡者血清SIRT1水平明显低于存活者(P<0.05)。ROC曲线分析显示,血清SIRT1预测CHF患者死亡的曲线下面积为0.740(95%CI:0.696~0.784,P<0.05),其cut off值为947.1 pg/m L,此时其预测患者死亡的敏感性、特异性分别为84.7%、80.4%。结论 CHF患者血清SIRT1水平明显降低,且心功能分级越差其水平越低;血清SIRT1水平有助于预测CHF患者预后。

Objective To investigate the value of silent information regulation 2 homolog 1（ SIRT1） in predicting the prognosis of patients with chronic heart failure（ CHF）. Methods A total of 136 CHF inpatients（ CHF group） and 50 healthy subjects（ control group） with matched age and sex receiving physical examination during the same period were selected. Venous blood was collected at 24 h after grouping to detect the serum SIRT1 and N-terminal pro-brain natriuretic peptide（ NT-pro BNP） levels by ELISA. The left ventricular end diastolic diameter（ LVEDD） and left ventricular ejection fraction（ LVEF） were measured by Vivid7 color ultrasound diagnostic apparatus. LVEDD was measured according to the standard measurements recommended by the American echocardiography society. LVEF was measured according to the improved Simpson method. All CHF patients were followed up for 2 years,with cardiovascular death as the endpoint event. In addition,patients＇ survival was recorded,and the evaluation value of serum SIRT1 level in predicting the prognosis for CHF patients was analyzed by using the receiver operating characteristic（ ROC） curve. Results Compared with the control group,the serum Sirt1 level in the CHF group was lower,and the serum SIRT1 level decreased gradually with the increase of New York Heart Association（ NYHA） grade of patients（ all P〈0. 05）. Spearman correlation analysis indicated the serum SIRT1 level was negatively correlated with NT-pro BNP level and left ventricular end-diastolic diameter（ LVEDD,whereas was significantly positively correlated with the left ventricular ejection fraction（ LVEF）（ all P〈0. 05）. Forty-five CHF patients（ 33. 09%） died of cardiovascular disease at the end of 2-year follow-up,and the serum SIRT1 level in dead CHF patients was significantly lower than that in the CHF patients alive（ P〈0. 05）. The ROC curve showed that the area under the curve of serum SIRT1 predicting the death of CHF patients 0. 740（ 95% CI： 0. 696-0. 784,P〈0. 05）,its value of cut off was 947. 1 pg/mL,and the sensitivity and specificity of the prediction were 84. 7% and 80. 4%,respectively.Conclusions CHF patients have notably lower serum SIRT1 level which is reduced with the increase of the NYHA level.Therefore,serum SIRT1 level is of great value to evaluate the prognosis of CHF patients.