血清游离脂肪酸波动程度对老年急性心力衰竭患者短期临床预后的评估价值

Predictive Value of Serum Free Fatty Acids in the Short-term Prognosis of Older Patients with Acute Heart Failure

目的探讨血清游离脂肪酸(FFA)波动程度对老年急性心力衰竭(AHF)患者短期临床预后的评估价值。方法选取老年AHF患者102例,根据出院后随访3个月结果,分为不良事件组(39例)和对照组(63例)。在入组和出院两个时间点,检测两组心功能指标、血脂、血清FFA和脂质氧化应激指标并进行统计学分析。结果出院时两组N末端B型脑钠肽前体(NT-proBNP)、丙二醛(MDA)、氧化应激指数(OSI)和血清总氧化态(TOS)均低于入组时,左室射血分数(LVEF)、总抗氧化态(TAS)均高于入组时,差异均有统计学意义(P<0.05);出院时对照组FFA低于入组时,miR-143高于入组时,差异均有统计学意义(P<0.05);出院时,不良事件组的FFA、MDA、OSI和TOS均高于对照组,TAS、miR-143低于对照组,差异均有统计学意义(P<0.05)。受试者工作特征曲线提示出院时-入组时FFA对于不良事件的预测价值最高,曲线下面积为0.832,cut-off值为0.30 mmol/L,灵敏度83.9%,特异度85.1%。logistic回归分析提示出院时-入组时FFA(≤0.30 mmol/L)和出院时-入组时miR-143(≤239.4 fmol/L)是老年AHF患者出院后3个月不良事件的独立危险因素。结论高水平FFA预示着老年AHF患者短期不良预后,可能与miR-143下降和脂质过氧化升高有关。

Objective To explore the predictive value of serum free fatty acids(FFA) in evaluating the short-term prognosis of older patients with acute heart failure(AHF).Methods A total of 102 older patients with AHF in Suining Center Hospital from March 2017 to June 2019 were enrolled in this study, and divided into the adverse event group(n=39) and control group(n=63) based on 3-month follow-up.The cardiac function, levels of lipids, FFA,and lipid oxidative stress indices in serum were measured at admission and discharge.Results The levels of N-terminal B-type pro-brain natriuretic peptide(NT-proBNP),malondialdehyde(MDA),oxidative stress index(OSI) and total oxidation state(TOS) were lower at discharge than those at admission in both groups, whereas left ventricular ejection fraction(LVEF) and the level of total antioxidant state(TAS) were higher, there were significant differences between the two groups(P<0.05).In the control group, the level of FFA was lower and level of miR-143 was higher at discharge than those at admission(P<0.05).In the adverse event group, the levels of FFA,MDA,OSI,and TOS were higher at discharge than those in the control group, whereas the levels of TAS and miR-143 were lower, there were significant differences between the two group(P<0.05).ROC curve analysis showed that the difference of FFA level between discharge and admission had the highest predictive value for adverse events.The area under the curve was 0.832,the cut-off value was 0.30 mmol/L,the sensitivity and specificity were 83.9% and 85.1%,respectively.Logistic regression analysis showed that the difference of FFA level between discharge and admission(≤0.30 mmol/L),and the difference of miR-143 level between discharge and admission(≤239.4 fmol/L) were independent risk factors for adverse events in older patients with AHF 3 months after discharge.Conclusion A high level of FFA may indicate a short-term poor prognosis in older patients with AHF,which may associated with reduced miR-143 and elevated lipid peroxidation.