血浆Periostin蛋白、嗜铬粒蛋白A、可溶性Sema 4D水平与扩张型心肌病慢性心力衰竭病人心功能分级和心室重构的相关性分析

Correlation between plasma levels of Periostin protein,chromaffin grain protein A,soluble Sema 4D and cardiac function grading,ventricular remodeling in patients with dilated cardiomyopathy and chronic heart failure

目的探讨扩张型心肌病(DCM)慢性心力衰竭(CHF)病人血浆中Periostin蛋白、嗜铬粒蛋白A(chromaffin grain pro-tein A,Cg A)、可溶性Sema 4D(sSema 4D)水平与心功能分级和心室重构的关系。方法选择在2017年10月至2019年9月期间正定县人民医院收治的154例DCM CHF病人,根据Weber心功能分级标准将受试者分为心功能轻度损害组(n=70),心功能中至重度损害组(n=84),正常对照组(n=50)。收集三组的临床资料,检测心功能及左室重构相关指标;酶联免疫吸附测定检测各组血浆Periostin蛋白、Cg A、sSema 4D水平,并进行相关性分析。结果心功能越差,血清Periostin蛋白、Cg A、sSema 4D水平逐渐增高,左心室舒张末内径(LVEDD)、左室舒张末期内径(LVESD)、左心房内径(LAD)、N端脑钠肽前体(NT-proBNP)和转化生长因子-β1(TGF-β1)水平逐渐增高,对照组Periostin蛋白、Cg A、sSema 4D、LVEDD、LVESD、LAD、NT-proBNP、TGF-β1分别为(75.49±8.71)ng/L、(62.25±6.32)μg/L、(427.25±82.19)ng/L、(49.25±4.62)mm、(27.75±5.87)mm、(45.22±5.74)mm、(1125.82±33.27)ng/L、(8.87±4.36)μg/L,心功能轻度损害组分别为(88.04±15.76)ng/L、(146.12±11.17)μg/L、(707.01±81.36)ng/L、(52.12±3.14)mm、(33.01±4.67)mm、(35.72±4.22)mm、(3872.31±621.4)ng/L、(44.17±5.34)μg/L,心功能中至重度损害组分别为(112.64±11.92)ng/L、(366.62±28.22)μg/L、(1087.51±81.27)ng/L、(57.74±4.83)mm、(37.01±7.33)mm、(49.79±4.72)mm、(7891.40±917.62)ng/L、(64.29±8.72)μg/L,各组比较差异有统计学意义(P<0.05);Periostin蛋白、Cg A、sSema 4D与LVEDD、LVESD、LAD、NT-proBNP、TGF-β1等和心室重构指标均呈正相关(均P<0.05);logistic回归分析显示,血清高水平Periostin蛋白、Cg A、TGF-β1以及高血压、冠心病是左室重构发生的危险因素(OR>1,P<0.05),血清低水平sSema 4D是左室重构发生的保护因素(OR<1,P<0.05)。结论DCM CHF病人血浆Periostin蛋白、Cg A、sSema 4D水平与心功能水平和心室重构关系密切,可能为DCM病人心衰的诊断、治疗及预后提供新的指导方向。

Objective To investigate the relationship between the levels of Periostin protein,chromaffin grain protein A(Cg A)and soluble Sema 4D(sSema 4D)in patients with dilated cardiomyopathy(DCM)chronic heart failure(CHF)and cardiac function grading and ventricular remodeling.Methods One hundred and fifty-four patients with DCM CHF who admitted to Zhengding County Peo-ple's Hospital from October 2017 to September 2019 were assigned into subjects with mild impairment of cardiac function group(n=70),moderate to severe impairment of cardiac function group(n=84)and normal control group(n=50)according to Weber's cardiac function grading criteria.The clinical data of three groups were collected to detect the related indexes of cardiac function and left ven-tricular remodeling.The levels of plasma Periostin protein,Cg A and sSema 4D were measure by enzyme-linked immunosorbent assay,and the correlation analysis was performed.Results The worse the cardiac function,the serum Periostin protein,Cg A,sSema 4D lev-els,the left ventricular end diastolic diameter(LVEDD),left ventricular end diastolic diameter(LVESD),left atrial inner diameter(LAD),N-terminal pro-brain natriuretic peptide(NT-proBNP)and transforming growth factor-β1(TGF-β1)levels gradually increased,Periostin protei,Cg A,sSema 4D,LVEDD,LVESD,LAD,NT-probNP,TGF-β1 in control group were(75.49±8.71)ng/L,(62.25±6.32)μg/L,(427.25±82.19)ng/L,(49.25±4.62)mm,(27.75±5.87)mm,(45.22±5.74)mm,(1125.82±33.27)ng/L,(8.87±4.36)μg/L,respec-tively,in mild impairment of cardiac function group were(88.04±15.76)ng/L,(146.12±11.17)μg/L,(707.01±81.36)ng/L,(52.12±3.14)mm,(33.01±4.67)mm,(35.72±4.22)mm,(3872.31±621.4)ng/L,(44.17±5.34)μg/L,respectively,and in moderate to severe impair-ment of cardiac function group were(112.64±11.92)ng/L,(366.62±28.22)μg/L,(1087.51±81.27)ng/L,(57.74±4.83)mm,(37.01±7.33)mm,(49.79±4.72)mm,(7891.40±917.62)ng/L,(64.29±8.72)μg/L,respectively,the difference between the different cardiac function groups was significant(P<0.05);Periostin protein,Cg A sSema 4D was positively correlated with LVEDD,LVESD,LAD,NT-proBNP,TGF-β1 and ventricular remodeling index(P<0.05);logistic regression analysis showed that serum high levels of Periostin pro-tein,Cg A,TGF-β1,hypertension,coronary heart disease were risk factors for left ventricular remodeling(OR>1,P<0.05),and serum low levels of sSema 4D was protective factor for left ventricular remodeling(OR<1,P<0.05).Conclusion The levels of plasma Perios-tin protein,Cg A and sSema 4D in patients with DCM CHF are closely related to cardiac function and ventricular remodeling,which may provide new directions for the diagnosis,treatment and prognosis of heart failure in patients with DCM.