高血压性心脏病患者血清血小板反应蛋白1、尿素氮水平及其与预后相关性

The level of serum thrombospondin 1,urea nitrogen and its correlation with prognosis in patients with hypertensive heart disease

目的分析高血压性心脏病患者血清血小板反应蛋白1(TSP-1)、尿素氮(BUN)水平及其与预后的相关性。方法选取2017年9月—2019年9月辽宁省人民医院/中国医科大学人民医院心内科收治的原发性高血压患者218例作为研究对象,根据是否合并心脏病分为高血压性心脏病组(高心组)113例,高血压组105例,另选取同期在医院体检的健康者100例作为健康对照组。比较3组心功能指标,血清TSP-1、BUN、高敏C反应蛋白(hs-CRP)、N末端B型利钠肽原(NT-proBNP)水平;分析高血压性心脏病患者血清TSP-1、BUN水平与hs-CRP、NT-proBNP及心功能指标相关性;采用Logistic回归模型分析影响高血压性心脏病患者不良预后发生的因素;利用ROC曲线评价血清TSP-1、BUN水平对高血压性心脏病患者不良预后发生的预测价值。结果健康对照组、高血压组、高心组患者血清TSP-1、BUN、hs-CRP、NT-proBNP及LVEDD、LVESD水平依次升高,LVEF、E/A水平依次降低(F=168.800、305.757、402.741、1260.743、101.909、77.043,364.696、737.701,P均=0.000)。预后不良亚组患者血清TSP-1、BUN、hs-CRP、NT-proBNP及LVEDD、LVESD水平明显高于预后良好亚组,LVEF、E/A水平明显低于预后良好亚组(t=15.591、13.719、11.412、4.016、6.700、6.901、10.584、15.463,P均=0.000)。高血压性心脏病患者血清TSP-1、BUN水平均与NT-proBNP、LVEDD呈正相关,与LVEF、E/A水平呈负相关(TSP-1:r/P=0.362/0.002、0.355/0.003、-0.403/0.000、-0.412/0.000;BUN:r/P=0.341/0.000、0.364/0.002、-0.415/0.000、-0.425/0.000)。Logistic回归分析结果表明,高hs-CRP水平、高NT-proBNP水平、高LVEDD、高TSP-1水平、高BUN水平是影响不良预后发生的危险因素[OR(95%CI)=2.819(1.400~5.675)、2.647(1.254~5.586)、3.106(1.586~6.084)、3.044(1.651~5.611)、3.185(1.766~5.745)],而高LVEF、E/A值是影响不良预后发生的保护因素[0.651(0.482~0.879)、0.596(0.447~0.795)]。血清TSP-1、BUN水平联合预测高血压性心脏病患者不良预后发生的曲线下面积为0.857,敏感度为92.30%,特异度为76.50%。结论高血压性心脏病患者血清TSP-1、BUN水平明显上调,与患者不良预后发生密切相关,可能作为评估患者预后的标志物。

Objective To investigate the expression levels of serum thrombospondin 1(TSP-1)and blood urea nitrogen(BUN)in patients with hypertensive heart disease and their prognostic correlation.Methods Two hundred and eighteen patients with primary hypertension admitted to the Department of Cardiology,People’s Hospital of Liaoning Provincial People’s Hospital/People’s Hospital of China Medical University from September 2017 to September 2019 were selected as the research objects,and they were divided into hypertensive heart disease groups according to whether they had complicated heart disease(There were 113 cases in the high heart group,105 cases in the hypertension group,and 100 healthy people who had a physical examination in the hospital during the same period were selected as the healthy control group.Compare the three groups of cardiac function indicators,serum TSP-1,BUN,serum high-sensitivity C-reactive protein(hs-CRP),N-terminal B-type natriuretic peptide(NT-proBNP)levels,and analyze serum TSP-1,BUN levels in patients with hypertensive heart disease Correlation with hs-CRP,NT-proBNP and cardiac function indicators;Logistic regression model was used to analyze the factors affecting the adverse prognosis of patients with hypertensive heart disease;ROC curve was used to evaluate serum TSP-1,BUN levels on the adverse prognosis of patients with hypertensive heart disease The predicted value of occurrence.Results Serum TSP-1,BUN,hs-CRP,NT-proBNP,LVEDD,and LVESD levels in the healthy control group,hypertension group,and high heart group patients increased sequentially,and the LVEF and E/A values decreased sequentially(F=168.800,305.757,402.741,1260.743,101.909,77.043,364.696,737.701,all P=0.000).The serum TSP-1,BUN,hs-CRP,NT-proBNP,LVEDD,and LVESD levels in the subgroup with poor prognosis were significantly higher than those in the subgroup with good prognosis,and the levels of LVEF and E/A were significantly lower than those in the subgroup with good prognosis(t=15.591,13.719,11.412,4.016,6.700,6.901,10.584,15.463,all P=0.000).Serum TSP-1 and BUN levels in patients with hypertensive heart disease are positively correlated with NT-proBNP and LVEDD,and negatively correlated with LVEF and E/A values(TSP-1:r/P=0.362/0.002,0.355/0.003,-0.403/0.000,-0.412/0.000;BUN:r/P=0.341/0.000,0.364/0.002,-0.415/0.000,-0.425/0.000).Logistic regression analysis showed that high hs-CRP level,high NT-proBNP level,high LVEDD,high TSP-1 level,and high BUN level are risk factors affecting the occurrence of poor prognosis[OR(95%CI)=2.819(1.400~5.675),2.647(1.254~5.586),3.106(1.586~6.084),3.044(1.651~5.611),3.185(1.766~5.745)],while high LVEF and high E/A value are protective factors of poor prognosis[0.651(0.482~0.879),0.596(0.447~0.795)].The area under the curve for the combination of serum TSP-1 and BUN levels to predict the adverse prognosis of patients with hypertensive heart disease was 0.857,the sensitivity was 92.30%,and the specificity was 76.50%.Conclusion Serum TSP-1 and BUN levels in patients with hypertensive heart disease are significantly up-regulated,which is closely related to the occurrence of poor prognosis of patients,and may be used as a marker for evaluating the prognosis of patients.