急性缺血性心力衰竭患者血清CIB1与pro-BNP的表达水平及意义

The expression levels and significance of serum CIB1 and pro-BNP in patients with acute ischemic heart failure

目的探讨急性缺血性心力衰竭患者血清钙整合素结合蛋白1(CIB1)与脑利钠肽前体(pro-BNP)表达水平及临床意义。方法选取2016年5月至2018年11月诊治的急性缺血性心力衰竭患者120例为研究组,根据美国纽约心脏病协会(NYHA)心功能分级分为Ⅱ级、Ⅲ级与Ⅳ级组,每组40例,另选取同期健康体检者40例为对照组。采用实时荧光定量PCR(qRT-PCR)法检测血清CIB1 mRNA表达水平;蛋白免疫印迹法检测CIB1蛋白表达情况;测定血清pro-BNP表达水平;并检测4组患者左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、肺动脉高压(PAH)水平及胸腔积液、心房颤动发生例数;对患者进行随访,统计发生心源性再住院及死亡情况;用Pearson法分析血清CIB1 mRNA与pro-BNP表达水平及临床特征的相关性;对影响急性缺血性心力衰竭患者预后因素进行COX回归分析。结果研究组(Ⅱ级、Ⅲ级、Ⅳ级组)血清CIB1 mRNA及蛋白表达水平低于对照组,且Ⅳ级组低于Ⅱ级组与Ⅲ级组,而研究组血清pro-BNP表达水平高于对照组,且Ⅳ级组高于Ⅱ级组与Ⅲ级组(P<0.05)。Ⅱ级组、Ⅲ级组、Ⅳ级组患者LVEF水平依次降低(P<0.05),LVEDD、PAH水平依次升高(P<0.05);Ⅳ级组胸腔积液患者比例高于Ⅱ级组(P<0.05);3组心房颤动患者比例比较差异无统计学意义(P>0.05)。血清pro-BNP表达水平与LVEF呈负相关(P<0.05),而CIB1 mRNA表达水平与LVEF呈正相关(P<0.05),LVEDD、PAH及胸腔积液均与Ⅳ级组血清CIB1 mRNA、pro-BNP表达水平呈正相关(P<0.05)。Pearson相关性分析显示急性缺血性心力衰竭患者血清CIB1 mRNA与pro-BNP表达水平呈显著负相关(P<0.05)。COX分析显示CIB1 mRNA、pro-BNP、LVEF与PAH是影响急性缺血性心力衰竭患者预后的危险因素。结论血清CIB1 mRNA、蛋白与pro-BNP表达水平能够作为临床诊断急性缺血性心力衰竭的生物学指标,并可作为评估患者预后的重要指标。

Objective To investigate the expression levels and significance of serum calcium and intergtin-binding protein(CIB1)as well as pro-brain natriuretic peptide(pro-BNP)in patients with acute ischemic heart failure(AIHF).Methods A total of 120 patients with AIHF who were treated in our hospital from May 2016 to November 2018 were enrolled in the study,who were divided into gradeⅡgroup,gradeⅢgroup and gradeⅣgroup according to the New York Heart Association(NYHA)cardiac function classification,with 40 cases in each group,at the sa me time,the other 40 healthy subjects were enrolled as control group.Quantitative real-time PCR(qRT-PCR)was used to detect the expression of CIB1 mRNA in serum,Western Blot was used to detect the expression levels of CIB1 protein and pro-BNP.Moreover the left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),pulmonary hypertension(PAH)levels,pleural effusion and atrial fibrillation were observed and compared between the two groups.In addition Pearson method was used to analyze the correlation between serum CIB1 mRNA,pro-BNP and the clinical characteristics,and the influencing factors on the prognosis of patients were analyzed by COX regression.Results The serum levels of CIB1 mRNA and protein in gradeⅡgroup,gradeⅢgroup and gradeⅣgroup were significantly lower than those in control group,moreover,which in gradeⅣgroup were significantly lower than those in gradeⅡgroup andⅢgroup,however,the expression levels of pro-BNP in the three groups were significantly higher than those in control group,which in gradeⅣgroup were significantly higher than those in gradeⅡgroup andⅢgroups(P<0.05).And the LVEF levels significantly decreased in order of gradeⅡgroup,gradeⅢgroup and gradeⅣgroup(P<0.05),and the levels of LVEDD and PAH were significantly increased in the order(P<0.05).The expression levels of pro-BNP were negatively correlated with those of LVEF(P<0.05),while the expression levels of CIB1 mRNA were positively correlated with those of LVEF(P<0.05),and the expression levels of LVEDD,PAH and pleural effusion volume were positively correlated with those of CIB1 mRNA and pro-BNP in gradeⅣgroup(P<0.05).Pearson correlation analysis showed that there was a significant negative correlation between serum levels CIB1 mRNA and those of pro-BNP in patients with AIHF(P<0.05).COX analysis showed that CIB1 mRNA,pro-BNP,LVEF and PAH were the risk factors affecting the prognosis of patients.Conclusion The expression levels of serum CIB1 mRNA,protein and pro-BNP can be regarded as the biological indexes for the clinical diagnosis of AIHF,can be regarded as the important indexes to evaluate the prognosis of patients.