血清铁蛋白水平在扩张型心肌病预后的预测价值

Predictive Value of Serum Ferritin Level in the Prognosis of Dilated Cardiomyopathy

目的探讨血清铁蛋白(SF)水平与扩张型心肌病(DCM)患者不良预后的相关性及其预测价值。方法纳入住院或门诊的DCM患者共156例,根据是否发生心源性死亡和因心衰再入院分为事件组(28例)和无事件组(128例),测定所有患者SF水平,分析两组间临床各项指标的差异,多因素Cox回归分析个因素与不良预后的相关性,ROC曲线分析SF对DCM不良预后的预测价值。结果平均随访(22.7±7.9)个月,两组间平均动脉压、血肌酐、血清肌钙蛋白以及左心室射血分数(LVEF)等,差异有统计学意义(P<0.001)。多因素Cox回归分析显示在校正年龄、性别、平均动脉压、血肌酐、肌钙蛋白及LVEF后,SF水平仍然对不良心脏事件具有独立预测价值(HR 0.76,95%CI 0.54~0.97,P=0.001)。ROC曲线分析显示SF对DCM患者不良心脏事件具有较好的预测价值,当SF为64.7 mg/L时预测不良事件的敏感度为90.1%,特异度为71.4%。结论SF与DCM患者不良心脏事件的独立预测因子,可作为患者临床危险分层、预后评估的重要标记物。

Objective To explore the correlation between serum ferritin(SF)level and poor prognosis of patients with dilated cardiomyopathy(DCM)and its predictive value.Method A total of 156 DCM patients were included in the inpatient or outpatient clinic.According to whether cardiogenic death and re-admission due to heart failure occurred,they were divided into event group(28 cases)and event-free group(128 cases).The SF levels of all patients were measured,and differences of various clinical indicators between two groups were analyzed.Multivariate Cox regression analyzed the correlation between each factor and poor prognosis,ROC curve analyzed the predictive value of SF on the poor prognosis of DCM.Results The average follow-up was(22.7±7.9)months.There were statistically significant differences in the average arterial pressure,blood creatinine,serum troponin,and left ventricular ejection fraction(P<0.001).Multivariate Cox regression analysis showed that after adjusting for age,gender,mean arterial pressure,blood creatinine,troponin and LVEF,SF levels still had independent predictive value for adverse cardiac events(HR 0.76,95%CI 0.54~0.97,P=0.001).ROC curve analysis showed that SF had a good predictive value for adverse cardiac events in DCM patients.When SF was 64.7 mg/L,the sensitivity of predicting adverse events was 90.1%and the specificity was 71.4%.Conclusion Independent predictors of adverse cardiac events in SF and DCM patients could be used as important markers for clinical risk stratification and prognosis assessment of patients.