血清游离脂肪酸对急性心力衰竭患者近期死亡风险的预测价值

Value of serum free fatty acid level to the prediction of short-term death risk of patients with acute heart failure

目的探讨急性心力衰竭(acute heart failure,AHF)患者近期死亡的危险因素,分析血清游离脂肪酸(free fatty acid,FFA)预测AHF患者近期死亡的价值。方法103例AHF患者均给予规范药物治疗,并进行随访。截至2019年12月,生存71例为生存组,死亡32例为死亡组。比较2组一般资料,入院时血清N末端B型脑钠肽前体(N-terminal brain natriuretic peptide,NT-proBNP)、FFA及估算肾小球滤过率(estimated glomerular filtration rate,eGFR)等指标;多因素Cox回归分析AHF患者近期死亡的影响因素;绘制ROC曲线,评估血清FFA对AHF患者近期死亡的预测价值。结果死亡组有心肌梗死病史比率(59.38%)及血清NT-proBNP[(5059.09±1674.26)ng/L、FFA[(1.34±0.25)mmol/L]水平均高于生存组[23.94%,(3479.48±1235.18)ng/L、(0.97±0.17)mmol/L](P<0.05),eGRF水平[(55.31±16.74)mL/(min·1.73m^(2))]低于生存组[(76.25±16.46)mL/(min·1.73m^(2))](P<0.05);2组年龄、性别比例、AHF家族史比率等一般资料及血清高敏C反应蛋白、肌钙蛋白I水平等比较差异均无统计学意义(P>0.05)。多因素Cox回归分析结果显示,心肌梗死病史(HR=6.810,95%CI:1.247~37.191,P=0.027)、NT-proBNP(HR=1.001,95%CI:1.000~1.002,P=0.002)及FFA(HR=1662.223,95%CI:21.54~8489.731,P=0.001)是AHF患者近期死亡的影响因素,eGFR(HR=0.927,95%CI:0.881~0.976,P=0.004)是其保护因素。ROC曲线分析结果显示,血清FFA以1.185mmol/L为最佳截断值,预测AHF患者近期死亡的AUC为0.904(95%CI:0.844~0.964,P<0.001),灵敏度为81.25%,特异度为90.14%。结论心肌梗死病史、血清NT-proBNP及FFA水平是AHF患者近期死亡的影响因素,血清FFA对AHF患者近期死亡风险有一定的预测价值。

Objective To investigate the risk factors of short-term death of patients with acute heart failure(AHF)and to investigate the value of serum free fatty acid(FFA)level to the prediction of short-term death of AHF patients.Methods Totally 103patients with AHF receiving standard drug treatment were followed up,and were divided into survival group(n=71)and death group(n=32)according to the final follow-up result in December,2019.The general data,and the levels of N-terminal brain natriuretic peptide(NT-proBNP),FFA and estimated glomerular filtration rate(eGFR)at admission were compared between two groups.Multivariate Cox regression analysis was performed to evaluate the influencing factors of short-term death of AHF patients.ROC was drawn to assess the value of FFA to the prediction of short-term death of AHF patients.Results The percentage of history of myocardial infarction and the levels of NT-proBNP and FFA were higher in death group(59.38%,(5059.09±1674.26)ng/L,(1.34±0.25)mmol/L)than those in survival group(23.94%,(3479.48±1235.18)ng/L,(0.97±0.17)mmol/L)(P<0.05),the level of eGRF was lower in death group((55.31±16.74)mL/(min·1.73 m^(2)))than that in survival group((76.25±16.46)mL/(min·1.73m^(2)))(P<0.05),and there were no significant differences in the age,sex ratio,AHF family history,serum high-sensitivity C-reactive protein and cardiac troponin I between two groups(P>0.05).Multivariate Cox regression analysis result showed the history of myocardial infarction(HR=6.810,95%CI:1.247-37.191,P=0.027),NT-proBNP(HR=1.001,95%CI:1.000-1.002,P=0.002)and FFA(HR=1662.223,95%CI:21.54-8489.731,P=0.001)were the influencing factors of short-term death of AHF patients,while eGFR(HR=0.927,95%CI:0.881-0.976,P=0.004)was the protective factor(P<0.05).ROC analysis showed when the optimal cut-offvalue of FFA was 1.185mmol/L,the AUCfor predicting short-term death was 0.904(95%CI:0.844-0.964,P<0.001),the sensitivity was 81.25%,and the specificity was 90.14%.Conclusion The history of myocardial infarction,and the serum levels of NT-proBNP and FFA are the influencing factors of short-term death of AHF patients,and the serum FFA has a certain value to the prediction of short-term death risk of AHF patients.