外周血管形成抑制素-2和骨膜蛋白对老年心肌梗死后心力衰竭预后评估价值

Prognostic value of peripheral blood VS-2 and Periostin in elderly patient with heart failure after myocardial infarction

目的探讨外周血管形成抑制素-2(VS-2)、骨膜蛋白(Periostin)对老年心肌梗死后心力衰竭预后评估价值。方法前瞻性纳入2018年3月-2020年3月我院收治的120例老年心肌梗死后心力衰竭患者作为观察对象(观察组),其中美国纽约心脏病协会心功能分级Ⅱ级46例、Ⅲ级43例、Ⅳ级31例,并根据患者的预后结局将其分为预后不良组(n=32)和预后良好组(n=88),另选取同期于我院行体检的健康者40例作为对照组。分别检测患者的血清外周血VS-2、Periostin和血清N末端脑肽钠前体水平及心功能指标,并收集患者的临床资料,并对所有患者进行为期1年的随访,分析外周血VS-2及Periostin与心功能指标的相关性,经单因素、多因素分析以上指标与疾病预后的相关性,并采用受试者工作曲线(ROC)下面积(AUC)分别评价各项指标对患者疾病的预后评估价值。结果(1)观察组中心功能Ⅱ级、Ⅲ级、Ⅳ级患者的血清Periostin、血清NT-PROBNP水平均明显高于对照组,外周血VS-2水平较对照组显著偏低,且随着患者心功能分级的升高,血清Periostin、血清NT-PROBNP水平呈上升趋势,外周血VS-2水平逐渐降低(P<0.05)。(2)观察组中心功能Ⅱ级、Ⅲ级、Ⅳ级患者的LVEDD、LVEDV及LVMI均明显高于对照组,LVEF较对照组偏低。患者心功能分级越高,LVEDD、LVEDV及LVMI越低,不同心功能分级患者间数据差异有统计学意义(P<0.05)。(3)外周血血清VS-2与LVEF呈正相关,与血清NT-PROBNP、LVEDD、LVEDV及LVMI均呈负相关;Periostin与LVEF呈负相关,与血清NT-PROBNP、LVEDD、LVEDV及LVMI呈正相关(P<0.05)。(4)在为期1年的随访中,32例患者预后不良,比例为26.67%(32/120)。预后不良组患者平均年龄与血清NT-PROBNP、LVEDD、LVEDV及LVMI及Periostin较预后良好组患者偏高,LVEF及外周血VS-2水平低于预后良好组,且两组患者心功能分级比例、合并高血压比例及合并糖尿病比例之间差异有统计学意义(P<0.05)。(5)LVEDD、LVEF及外周血VS-2、Periostin和血清NT-PROBNP水平均是影响老年心肌梗死后心力衰竭患者预后的独立危险因素。(6)血清外周血VS-2、Periostin水平对预测预后的AUC分别为0.922、0.844(P<0.05)。结论老年心肌梗死后心力衰竭患者普遍存在血清外周血VS-2水平降低、Periostin水平升高,两项血清因子均是影响老年心肌梗死后心力衰竭患者预后不良的独立危险因素,可作为预测此类患者预后的参考指标。

Objective To explore the prognostic value of vasopressin-2(VS-2)and proteins in peripheral blood in elderly patients with heart failure after myocardial infarction.Methods A total of 120 elderly patients with heart failure after myocardial infarction who were admitted to our hospital from March 2018 to March 2020 were prospectively included as observation subjects(observation group).Among them,there were 46 cases in ClassⅡ,43 cases in ClassⅢ,and 31 cases in ClassⅣaccording to the Functional C.lassification of new york Heart Association.According to the prognosis of patients,they were divided into the group with poor prognosis(n=32)and the group with good prognosis(n=88).In addition,40 healthy subjects who underwent physical examination at the same time in our hospital were selected as control group.Serum levels of peripheral angiostatin-2,periosteal protein,serum N-terminal pro-brain natriuretic peptide and cardiac function indicators were measured in all patients,and the clinical data were collected.All patients were followed up for one year to analyze the correlation between peripheral angiostatin-2,periosteal protein and cardiac function indicators.After univariate and multivariate analysis,the correlation between the above indicators and disease prognosis was analyzed.The area under the working curve(ROC)(AUC)of the subjects was used to evaluate the prognostic evaluation value of each indicator for diseases in patients.Results(1)In the observation group,the levels of serum Peristatin and serum NT-PROBNP of patients with gradeⅡ,ⅢandⅣcentral function were significantly higher than those of the control group,and the level of peripheral blood VS-2 was significantly lower than that of the control group.With the increase of the cardiac function grade of patients,the levels of serum Peristatin and serum NT-PROBNP were increasing,and the level of peripheral blood VS-2 was gradually decreasing(P<0.05).(2)The LVEDD,LVEDV,and LVMI of patients with central function classⅠ,ⅡandⅣin the observation group were significantly higher than those of the control group,and the LVEF was lower than that of the control group.The higher the cardiac functional grade was,the lower the LVEDD,LVEDV,and LVMI would be,and the data between patients with different cardiac functional grades would be significantly different(P<0.05).(3)Serum VS-2 showed positive correlation with LVEF and negative correlation with NT-PROBNP,LVEDD,LVEDV and LVMI;Periostin was negatively correlated with LVEF,and positively correlated with serum NT-PROBNP,LVEDD,LVEDV,and LVMI(P<0.05).(4)During the one-year follow-up,32 patients(26.67%(32/120))had poor prognosis.The mean age and serum levels of NT-PROBNP,LVEDD,LVEDV,LVMI,and Periostin were higher in the poor prognosis group than in the good prognosis group.The LVEF and peripheral blood VS-2 levels were lower than in the good prognosis group.Moreover,there were significant differences in the proportion of cardiac functional classification,the proportion of patients with hypertension and the proportion of patients with diabetes between the two groups(P<0.05).(5)LVEDD,LVEF,peripheral blood VS-2,Periostin and serum NT-PROBNP levels are all independent risk factors affecting the prognosis of elderly patients with heart failure after myocardial infarction.(6)The AUC of serum VS-2 and Periostin in predicting prognosis was 0.922 and 0.844,respectively(P<0.05).Conclusion The elderly patients with heart failure after myocardial infarction generally have decreased serum peripheral angiostatin-2 level and increased periosteal protein level.Both serum factors are independent risk factors for poor prognosis of elderly patients with heart failure after myocardial infarction,and can be used as a reference index for predicting the prognosis of such patients.