原发性高血压合并心力衰竭患者血清神经调节蛋白-1与心室重塑的相关性分析

Correlation between serum neuregulin-1 and ventricular remodeling in patients with essential hypertension and heart failure

目的探讨原发性高血压合并心力衰竭(以下简称心衰)患者血清神经调节蛋白-1(NRG-1)水平与心室重塑的相关性。方法选取2019年1月—2020年12月东部战区总医院收治的原发性高血压合并心衰患者216例作为观察组,另取同期该院131例原发性高血压未合并心衰患者作为对照组。比较两组患者一般情况、实验室指标、心功能指标及左室重塑指数。采用多因素逐步Logistic回归模型分析原发性高血压患者发生心衰的危险因素。将216例原发性高血压合并心衰患者根据美国纽约心脏病协会心功能分级不同分为Ⅱ级81例,Ⅲ级106例,Ⅳ级29例,比较不同心功能分级患者血清NRG-1水平及左室重塑指数。采用Pearson法分析血清NRG-1水平与心功能指标、左心室重塑指数及心衰程度的相关性。结果两组患者高血压病程、空腹血糖、总胆固醇、甘油三酯、血清N端前体脑钠肽、肌酸激酶MB同工酶、C反应蛋白、NRG-1、左心室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左心室射血分数(LVEF)、左室重塑指数比较,差异有统计学意义(P<0.05)。多因素逐步Logistic回归分析结果显示:高血压病程长[■=3.037(95%CI:1.874,6.593)]、空腹血糖高[■=2.316(95%CI:1.405,4.226)]、总胆固醇高[■=2.142(95%CI:1.310,3.475)]、甘油三酯高[■=3.593(95%CI:2.017,8.450)]、NRG-1水平高[■=2.244(95%CI:1.113,3.792)]、左心室重塑指数小[■=3.593(95%CI:1.859,8.905)]是原发性高血压患者发生心衰的危险因素(P<0.05)。Ⅱ级、Ⅲ级、Ⅳ级心功能患者血清NRG-1水平逐渐升高(P<0.05),左室重塑指数逐渐降低(P<0.05)。原发性高血压合并心衰患者血清NRG-1水平与LVEDD、LVESD、心衰程度呈正相关(r=0.605、0.738和0.634,均P<0.05),与LVEF、左室重塑指数呈负相关(r=-0.667和-0.527,均P<0.05)。结论NRG-1水平、左室重塑指数均是原发性高血压患者发生心衰的危险因素,血清NRG-1水平与原发性高血压合并心衰患者左心室重塑指数呈负相关。

Objective To investigate the correlation between serum neuregulin-1(NRG-1)and ventricular remodeling in patients with essential hypertension and heart failure.Methods A total of 216 patients with essential hypertension complicating heart failure and 131 essential hypertension patients without heart failure in our hospital from January 2019 to December 2020 were enrolled as observation group and control group,respectively.The general conditions,laboratory indexes,cardiac parameters,and left ventricular remodelling index were compared between groups.Multivariate Logistic regression analysis was used to screen the risk factors of heart failure in essential hypertension patients.The observation group was further divided into subgroups according to New York Heart Association(NYHA)classification,including gradeⅡgroup(n=81),gradeⅢgroup(n=106),and gradeⅣgroup(n=29).The left ventricular remodeling index and serum NRG-1 levels were compared among the three subgroups.Pearson method was applied to analyze the correlation between serum NRG-1 level and cardiac parameters,left ventricular remodeling index and the severity of heart failure.Results The course of hypertension,the levels of fasting blood glucose,total cholesterol,triglyceride,N-terminal pro-B-type natriuretic peptide(NTproBNP),creatine kinase-MB(CK-MB),C-reactive protein(CRP),and NRG-1,left ventricular end-diastolic dimension(LVEDD),left ventricular end-systolic dimension(LVESD),left ventricular ejection fraction(LVEF),and left ventricular remodeling index showed significant differences between observation group and control group(P<0.05).Multivariate Logistic regression analysis showed that long-term course of hypertension[■=3.037(95%CI:1.874,6.593)],elevated levels of fasting blood glucose[■=2.316(95%CI:1.405,4.226)],total cholesterol[■=2.142(95%CI:1.310,3.475)],triglyceride[■=3.593(95%CI:2.017,8.450)],and NRG-1[■=2.244(95%CI:1.113,3.792)],and low left ventricular remodeling index[■=3.593(95%CI:1.859,8.905)]were contributing factors for the development of heart failure in patients with essential hypertension(P<0.05).Among three subgroups,serum NRG-1 level was the lowest in gradeⅡgroup,followed by gradeⅢgroup,and was the highest in gradeⅣgroup(P<0.05).Meanwhile,the left ventricular remodeling index was the highest in gradeⅡgroup,followed by gradeⅢgroup,and was the lowest in gradeⅣgroup(P<0.05).Serum NRG-1 levels in essential hypertension patients with heart failure were positively correlated with LVEDD,LVESD and the severity of heart failure(r=0.605,0.738 and 0.634,all P<0.05),and negatively correlated with LVEF and left ventricular remodeling index(r=-0.667 and-0.527,both P<0.05).Conclusions NRG-1 level and left ventricular remodeling index are risk factors that affect the development of heart failure in patients with essential hypertension,and the serum NRG-1 level shows a negative correlation with left ventricular remodeling index in patients with essential hypertension and heart failure.