二氧化碳斜率和半乳糖凝集素-3在慢性心力衰竭心功能分级评估及心脏不良事件预测中的价值

Value of carbon dioxide slope and galectin-3 to review of heart function classification and prediction of major adverse cardiovascular events in patients with chronic heart failure

目的分析二氧化碳斜率(VE/VCO2 slope)和半乳糖凝集素-3(Gal-3)在慢性心力衰竭(心衰)心功能分级评估及心脏不良事件预测中的价值,并探讨相关影响因素。方法选取2017年1月至2018年9月于济南市人民医院和济南市第四人民医院收治的138例慢性心衰(Ⅱ级22例、Ⅲ级69例和Ⅳ级47例)患者作为实验组,根据左室射血分数(LVEF)又可将其分为收缩性心衰(n=95)和舒张性心衰(n=43);选取同期与实验组性别、年龄及体质指数等一般资料无明显差异的50例健康体检者作为对照组。对所有研究对象进行VE/VCO2斜率和血清Gal-3检测,出院后随访90 d,记录心脏不良事件。比较不同分级和不同类型慢性心衰患者VE/VCO2斜率、血清Gal-3和主要心脏不良事件差异,并分析VE/VCO2斜率和血清Gal-3与心脏不良事件之间的关系,同时采用多因素Logistic回归分析探讨导致慢性心衰并发主要心脏不良事件的独立危险因素。结果与对照组比较,实验组VE/VCO2斜率和血清Gal-3增高,差异有统计学意义(P<0.05)。心功能分级不同,其VE/VCO2斜率、血清Gal-3和MACE发生率明显差异,有统计学意义(P<0.05),由小到大依次为心功能Ⅱ级、Ⅲ级和Ⅳ级。收缩性心衰VE/VCO2斜率、血清Gal-3和MACE发生率均高于舒张性心衰,差异有统计学意义(P<0.05)。经Spearman分析得知,VE/VCO2斜率、Gal-3与MACE之间均呈正相关(P<0.05),其R值分别为0.842和0.795。经多因素Logistic回归分析得知,NYHA心功能分级(Ⅲ级)、心衰类型(收缩性心衰)、VE/VCO2斜率和血清Gal-3是影响慢性心衰并发MACE的独立危险因素(P<0.05)。结论VE/VCO2斜率和Gal-3在不同类型和不同NYHA心功能分级慢性心衰中差异明显,是并发心脏不良事件的独立危险因素。

Objective To analyze the value of carbon dioxide slope(VE/VCO2 slope)and galectin-3(Gal-3)to review of heart function classification(NYHA classes)and prediction of major adverse cardiovascular events(MACE)in patients with chronic heart failure(CHF),and to discuss the correlated influencing factors.Methods CHF patients(n=138,22 of NYHA Ⅱ class,69 of NYHA Ⅲ class and 47 of NYHA Ⅳ class)were chosen into test group from People’s Hospital of Jinan City and the fourth People’s Hospital of Jinan City from Jan.2017 to Sept.2018.The test group was divided,according to LVEF level,into systolic heart failure group(SHF group,n=95)and diastolic heart failure group(DHF group,n=43).At the same time,the healthy controls(n=50)without significant difference in sex,age and body mass index(BMI)compared with test group were chosen into control group.All groups were given detections of VE/VCO2 slope and Gal-3,and MACE incidence was recorded after patients discharged for 90 d.The difference in VE/VCO2 slope,Gal-3 and MACE incidence was compared among different NYHA classes and different groups,and relationship among VE/VCO2 slope,Gal-3 and MACE incidence was analyzed.The independent risk factors of CHF complicated by MACE were investigated by using multifactor Logistic regression analysis.Results Compared with control group,VE/VCO2 slope and Gal-3 increased in test group(P<0.05).There was significant difference in VE/VCO2 slope,Gal-3 and MACE incidence rate among different NYHA classes(P<0.05)in an ascending sequence of NYHA Ⅱ class,NYHA Ⅲ class and NYHA Ⅳ class.VE/VCO2 slope,Gal-3 and MACE incidence rate were all higher in SHF group than those in DHF group(P<0.05).The results of Spearman analysis showed that VE/VCO2 slope and MACE(r=0.842)and Gal-3 and MACE(r=0.795)had positive correlation(P<0.05).The results of Logistic regression analysis showed that NYHA(Ⅲ class),type of HF(DHF),VE/VCO2 slope and Gal-3 were independent risk factors of CHF complicated by MACE(P<0.05).Conclusion VE/VCO2 slope and Gal-3 have significant difference among different HF types and different NYHA classes,and they are independent factors of CHF complicated by MACE.