血清CTRP3对老年急性心力衰竭并发急性肾损伤患者的早期诊断与预后评估价值

Effect of CTRP3 on Acute Kidney Injury in Elderly Patients with Acute Heart Failure and Its Correlation with Prognosis

目的:分析血清CTRP3对老年急性心力衰竭患者并发急性肾损伤(acute kidney injury,AKI)的早期诊断价值,同时评估其与预后的相关性。方法:选择老年急性心力衰竭患者(年龄≥60岁)232例,包括新发急性心力衰竭及慢性心力衰竭急性加重,根据入院后48 h内血清肌酐水平,分成心力衰竭并发急性肾损伤组(AKI组)和心力衰竭未并发急性肾损伤组(非AKI组),测定血清CTRP3、氨基末端脑钠肽前体(NT-proBNP)、胱抑素C等相关指标,采用Pearson相关性分析血清CTRP3与各临床指标之间的相关性,采用logistic多元回归分析急性心力衰竭患者并发AKI的危险因素及预后不良因素。结果:AKI组血清CTRP3表达水平为(231.79±24.63) ng/mL,低于非AKI组的(257.87±24.37) ng/mL(P<0.05),AKI组急性肾损伤分期越高,其血清CTRP3水平越低(P<0.05)。AKI组血清CTRP3表达水平与血肌酐(Scr)呈负相关(P<0.05),与肾小球滤过率(eGFR)、肿瘤坏死因子α(TNF-α)、白介素-6(IL-6)均呈正相关(P<0.05),非AKI组CTRP3与FBG、TG均呈负相关(P<0.05)。多因素logistic分析显示,CTRP3表达水平降低(≤248 ng/mL)是心力衰竭并发AKI的独立危险因素[OR=2.939,95%CI(1.133,7.623),P<0.05]。logistic回归分析显示,eGFR为患者近期预后不良的保护因素,CTRP3表达水平降低(≤248 ng/mL)、血肌酐(Scr)、年龄、糖尿病、高血压是患者的近期预后不良危险因素(P<0.05)。结论:血清CTRP3表达水平降低是急性心力衰竭患者并发AKI的危险因素及预后不良因素。

Objective:To analyze the value of serum CTRP3 in the early diagnosis of acute kidney injury (AKI) in elderly patients with acute heart failure,and to evaluate its correlation with prognosis.Method:A total of 232 elderly patients with acute heart failure (age 60 years or older) were selected,including new-onset acute heart failure and acute decompensation of chronic heart failure.They were divided into heart failure with acute kidney injury group (AKI group) and heart failure without acute kidney injury group (non-AKI group) according to serum creatinine level within 48 hours after admission.The serum CTRP3,NT-proBNP,cystatin C and other related indicators were measured.Pearson correlation analysis was used to analyze the correlation between serum CTRP3 and clinical parameters.logistic multiple regression was used to analyze the risk factors and poor prognosis of AKI in patients with acute heart failure.Result:The serum CTRP3 level in the AKI group was (231.79±24.63) ng/mL,which was lower than (257.87±24.37) ng/mL in the non-AKI group (P<0.05).The higher the stage of acute kidney injury,the lower the serum CTRP3 level (P<0.05).There were negative correlation between serum CTRP3 level and serum creatinine (Scr) (P<0.05),there were positive correlation with glomerular filtration rate (eGFR),TNF-αand IL-6 in AKI group (P<0.05).There was a negative correlation between CTRP3 and FBG,TG in the non-AKI group (P<0.05).Multivariate logistic analysis showed that the low expression of CTRP3 (≤248 ng/mL) was an independent risk factor for AKI[OR=2.939,95%CI (1.133,7.623),P<0.05].logistic regression analysis showed that eGFR was a protective factor for poor short-term prognosis,and the reduced expression level of CTRP3 (≤248 ng/mL),serum creatinine (Scr),age,diabetes and hypertension were the risk factors for poor short-term prognosis (P<0.05).Conclusion:Decreased serum CTRP3 is a risk factor and a poor prognostic factor for AKI in patients with acute heart failure.