慢性心力衰竭患者血浆cMyBP-C水平的变化

Changes of plasma cMyBP-C level in patients with chronic heart failure

目的:探讨慢性心力衰竭(CHF)患者血浆中心脏型肌球蛋白结合蛋白-C(cMyBP-C)水平变化及其对近期预后的预测价值。方法:选取89例新入院确诊为CHF的患者为CHF组,30名健康体检者为对照组。收集所有受试者入院时及CHF组治疗1个月后的血浆样本,检测其cMyBP-C水平。彩色多普勒超声心动图仪检测左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)及E/A比值等。对cMyBP-C与心力衰竭指标进行相关性分析。对CHF组进行为期12个月的临床随访,记录主要不良心血管事件(MACE)的发生情况。用COX回归分析并绘制ROC曲线评价血浆cMyBP-C表达水平对CHF近期预后的预测价值。结果:CHF组患者入院时cMyBP-C血浆水平较对照组入院时明显升高[(137.07±44.44)ng/ml∶(29.29±10.37)ng/ml,P<0.01];CHF组患者治疗1个月后与入院时相比较明显降低[(84.67±37.98)ng/ml∶(137.07±44.44)ng/ml,P<0.01]。Pearson相关分析显示,CHF患者入院时血浆cMyBP-C水平与B型脑钠肽前体(proBNP)呈正相关性(r=0.711,P<0.01),与LVEF、LVFS、E/A比值均呈负相关性(r=-0.659、-0.457、-0.478,均P<0.01)。Spearman相关性分析显示,CHF患者入院时血浆cMyBP-C水平与NYHA分级呈正相关性(r=0.756,P<0.01)。Cox回归分析结果显示,入院时血浆cMyBP-C水平是近期发生MACE的独立危险因素(HR=1.024,95%CI:1.001~1.048,P=0.044)。ROC结果显示,入院时血浆cMyBP-C水平预测CHF患者近期发生MACE的曲线下面积为0.805(95%CI:0.688~0.922),截点值为154.71 ng/ml,灵敏度为84.2%,特异度为74.1%。结论:cMyBP-C在CHF患者血浆中的表达水平可能发生改变,可为预测患者近期内MACE的发生风险提供参考。

Objective:To investigate changes of plasma cardiac myosin binding protein-C(cMyBP-C)in patients with chronic heart failure(CHF)and the predictive value for short term prognosis.Method:A total of 89 patients with CHF were selected as CHF group.Another 30 healthy people were selected as the control group.Plasma samples from all subjects at the admission time and from patients in the CHF group after 1 month of treatment were collected to test cMyBP-C levels.Left ventricular ejection fraction(LVEF),left ventricular short axis shortening rate(LVFS)and E/A ratio were measured by echocardiography.Correlation analysis between cMyBP-C and heart failure index was performed.All patients were followed up for 12 months to record the occurrence of major adverse cardiovascular events(MACE).The predictive value of the plasma level of cMyBP-C for short term prognosis was evaluated by COX regression analysis and ROC curve.Result:The plasma level of cMyBP-C in the CHF group at admission was significantly higher than that in the control group[(137.07±44.44)ng/ml vs(29.29±10.37)ng/ml,P<0.01].In the CHF group,the plasma level of cMyBP-C after 1 month of treatment was significantly lower than that at admission[(84.67±37.98)ng/ml vs(137.07±44.44)ng/ml,P<0.01].Pearson analysis showed that the plasma cMyBP-C level was positively correlated with proBNP in patients with CHF(r=0.711,P<0.01),and negatively correlated with LVEF,LVFS and E/A ratio(r=-0.659,-0.457,-0.478,all P<0.01).Spearman analysis showed that the level of plasma cMyBP-C in patients with CHF was positively correlated with NYHA classification(r=0.756,P<0.01).Cox regression analysis showed that the plasma level of cMyBP-C at admission was an independent risk factor for short-term MACE(HR=1.024,95%CI:1.001-1.048,P=0.044).ROC showed that the AUC of cMyBP-C at admission for predicting short-term MACE in CHF patients was 0.805,the cutoff value was 154.71 ng/ml,the sensitivity was 84.2%,and the specificity was 74.1%.Conclusion:The expression of cMyBP-C in patients with CHF may change,which can provide a reference for predicting the risk of short-term MACE.