β2-微球蛋白与老年慢性心力衰竭患者预后关系的研究

Relationship between β2-Microglobulin and Prognosis of Elderly Patients with Chronic Heart Failure

目的探讨β2-微球蛋白(β2-microglobulin,β2-MG)对老年慢性心力衰竭患者预后的预测价值。方法选择2015年11月至2018年12月在北京老年医院心血管内科住院的185例慢性心力衰竭患者为研究对象,回顾性收集患者的相关病历资料,包括一般资料、检查及治疗结果,并记录相关数据。中位随访时间为25个月(95%置信区间[CI]为19~31),以全因死亡为随访终点。根据随访结果对比不同预后患者β2-MG水平,通过受试者工作特征(receiver operating characteristic,ROC)曲线计算β2-MG的临界值,以Kaplan-Meier法绘制生存曲线,并以Log-Rank检验对生存时间进行分析。结果185例患者中男98例,女87例,年龄为28~96岁,平均(73.8±11.9)岁;121例患者出现全因死亡,64例患者存活。死亡组患者血清β2-MG水平显著高于存活组[(8.4±7.6)mg/L比(4.2±2.7)mg/L,P<0.001]。ROC曲线分析结果显示:β2-MG对慢性心力衰竭患者不良预后的最佳预测临界值为5.065 mg/L,灵敏度为80.6%,特异度为55.9%,曲线下面积(area under the curve,AUC)为0.734,95%CI为0.658~0.810。根据ROC分析结果将患者分为2个亚组:β2-MG≥5.065 mg/L组(81例)和β2-MG<5.065 mg/L组(104例)。Kaplan-Meier单因素分析法显示,β2-MG≥5.065 mg/L组中位生存时间为(16.0±2.5)个月,β2-MG<5.065 mg/L组中位生存时间为(38.0±6.6)个月(P<0.001)。结论慢性心力衰竭患者血清β2-MG水平≥5.065 mg/L时预后较差,患者生存时间显著低于血清β2-MG水平<5.065 mg/L者,该指标可作为慢性心力衰竭患者的预后预测因子。

Objective To evaluate the prognostic value of β2-microglobulin(β2-MG)in eld erly patients with chronic heart failure(CHF).Methods A total of 185 patients with chronic heart failure hospitalized in Department of Cardiology of Beijing Geriatric Hospital from November 2015 to December 2018 were selected as the research objects.The relevant medical records of the patients were collected retrospectively,including general information,laboratory test,examination and treatment,and the relevant data were recorded.The median follow-up time was 25 months(95% confidence interval[CI]:19-31),with all-cause death as the end point.The levels of β2-MG in patients between survivors and non-survivors were compared.The cut-off value of β2-MG was calculated by receiver operating characteristic(ROC)curve.Survival curves were constructed using the Kaplan-Meier method and were compared by Log Rank tests.Results All-cause death occurred in 121 patients.β2-MG was significantly elevated in the non-survivors than that in survivors(8.4±7.6 vs 4.2±2.7 mg/L,P<0.001).The optimal cut-off value of β2-MG to predict all-cause mortality was 5.065 mg/L by ROC curve analysis with a sensitivity of 80.6% and specificity of 55.9%(AUC=0.734,95%CI:0.658-0.810).Patients were divided into two subgroups of β2-MG with a threshold of 5.065 mg/L.Median survival time were(16.0±2.5)months in patients with β2-MG≥5.065 mg/L and(38.0±6.6)months in patients with β2-MG<5.065 mg/L(P<0.001).Conclusions Serumβ2-MG level≥5.065 mg/L in elderly patients with chronic heart failure has a poor prognosis,and the survival time of patients is significantly shorter than that of patients with serum β2-MG level<5.065 mg/L,which can be used as a prognostic predictor of patients with chronic heart failure.