心力衰竭患者血清D-D、Cys-C、NT-proBNP、hs-cTnI和CRP水平及其对预后评估的价值

Level of serum D-dimer,Cys-C,NT-proBNP,hs-cTnI and CRP and the prognostic value in patients with heart failure

目的分析心力衰竭患者血清二聚体(D-D)、胱抑素C(Cys-C)、N末端B型脑钠肽原(NT-proBNP)和超敏心肌肌钙蛋白I(hs-cTnI)和C反应蛋白(CRP)水平及其在预后评估中的价值。方法回顾性选取2017年7月至2020年1月滁州市中西医结合医院收治的81例心力衰竭患者纳入心力衰竭组,选择同时间段50名健康人纳入对照组。比较心力衰竭组与对照组血清D-D、Cys-C、NT-proBNP、hs-cTnI及CRP水平;分析心力衰竭组美国纽约心脏病协会(NYHA)不同分级组、不同预后患者的血清D-D、Cys-C、NT-proBNP、hs-cTnI及CRP水平;Logistic回归分析心力衰竭患者预后;分析血清D-D、Cys-C、NT-proBNP、hs-cTnI及CRP对心力衰竭预后不良的预测价值。结果心力衰竭组血清D-D、Cys-C、NT-proBNP、hs-cTnI及CRP水平均高于对照组,差异均有统计学意义(P<0.05),且心力衰竭组中随着心功能级别的升高,D-D、Cys-C、NT-proBNP、hs-cTnI及CRP水平越高(P<0.05)。随访1年后,心力衰竭组中28例(5例死亡,23例再次入院)纳入事件组,53例纳入无事件组。事件组血清D-D、Cys-C、NT-proBNP、hs-cTnI及CRP水平均高于无事件组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果也显示,血清中上述5个指标均为心力衰竭患者预后不良的的危险因素(P<0.05)。受试者工作特征曲线分析显示,血清D-D、Cys-C、NT-proBNP、hs-cTnI及CRP均对预后不良均有一定预测价值(曲线下面积分别为0.712,0.725,0.879,0.862,0.704,均P<0.05),且5个指标联合检测的曲线下面积、敏感度、特异度分别为0.978,99.1%、100.0%,预测价值高于单个指标。结论血清D-D、Cys-C、NT-proBNP、hs-cTnI及CRP水平与心力衰竭严重程度及预后相关联,5种指标可作为心力衰竭预后评估的有效指标。

Objective To investigate the application value of serum D-dimer(D-D),cystatin C(Cys-C),N-terminal B-type natriuretic peptide(NT-proBNP),hypersensitive cardiac troponin I(hs-cTnI)and C-reactive protein(CRP)in the prognostic assessment of heart failure.Methods From July 2017 to January 2020,81 patients with heart failure admitted to the Chuzhou Hospital of Integrated Traditional Chinese and Western Medicine were retrospectively selected and included in the heart failure group,and 50 healthy people at the same time period were selected and included in the control group.The levels of serum DD,Cys-C,NT-proBNP,hs-cTnI and CRP in the heart failure group and the control group were compared.In the heart failure group,the serum DD,Cys-C,NT-proBNP,hs-cTnI and CRP levels of the New York Heart Association(NYHA)patients with different grades and different prognosis were analyzed.The predictive value of serum DD,Cys-C NT-proBNP,hs-cTnI and CRP on poor prognosis of heart failure was analyzed by Logistic regression.Results Serum NT-proBNP,hs-cTnI,CRP,D-D and Cys-C in HF group were all much higher than those in control group,the differences were statistically significant(P<0.05).All the indexes in heart failure group showedⅣgrade>Ⅲgrade>Ⅱgrade.There were significant differences between any two grades(P<0.05).Among 81 heart failure patients,the terminal event occurred in 28 cases after 1 year follow-up.Among them,5 cases died and 23 cases were re-hospitalized.28 cases were all included in the event group,other HF patients were included in the non-event group.The serum levels of D-D,Cys-C,NT-proBNP,hs-cTnI and CRP in the event group were higher than those in the non-event group,the differences were statistically significant(P<0.05).Binary Logistic regression analysis showed that D-D,Cys-C,NT-proBNP,hs-cTnI and CRP were all risk factors for adverse prognosis in patients with HF.receiver operating characteristic curve analysis showed that serum D-D,Cys-C,NT-proBNP,hs-cTnI and CRP had certain predictive value for the adverse prognosis of heart failure(area under the curve was 0.712,0.725,0.879,0.862,0.704,P<0.05),and the area under the curve of the combined detection of the five indexes was 0.978,the sensitivity and specificity were99.1%and 100%,respectively,and the predictive value was high.Conclusion Serum D-D,Cys-C,NT-proBNP,hs-cTnI and CRP are associated with the severity and prognosis of heart failure.Five indexes above can be used as effective indexes to evaluate the prognosis of heart failure.