慢性心力衰竭患者血清MR-ProADM、Gal-3、GDF-15表达及临床意义

Expression and clinical significance of serum MR-ProADM,Gal-3 and GDF-15 in patients with chronic heart failure

目的 分析肾上腺髓质中段肽(MR-ProADM)、半乳糖凝集素-3(Gal-3)、生长分化因子-15(GDF-15)在慢性心力衰竭(CHF)患者血清中的表达及临床意义。方法 选取该院2019年5月至2020年7月收治的110例CHF患者作为CHF组,以及同期因原发性高血压或心律失常住院的40例患者作为对照组,检测两组血清MR-ProADM、Gal-3、GDF-15水平。按美国纽约心脏病协会(NYHA)心功能分级,将CHF组分为甲(Ⅱ级)、乙(Ⅲ级)、丙(Ⅳ级)3组,比较不同NYHA分级患者以上指标的差异。按随访1年是否发生终点事件(再次心力衰竭入院或全因死亡)分为事件组和非事件组,采用单因素及多因素Logistic回归分析筛选CHF患者发生终点事件的危险因素,采用受试者工作特征(ROC)曲线分析MR-ProADM、Gal-3、GDF-15对CHF患者预后的评估价值。结果 CHF组MR-ProADM、Gal-3、GDF-15水平较对照组高(P<0.05),乙组、丙组MR-ProADM、Gal-3、GDF-15水平较甲组高(P<0.05),丙组Gal-3表达水平明显高于乙组(P<0.05)。随访1年,共有36例(32.73%)患者发生终点事件,事件组入组时MR-ProADM、Gal-3、GDF-15水平均高于非事件组(P<0.05)。多因素Logistic回归分析显示,MR-ProADM、Gal-3、GDF-15、年龄、脑钠肽(BNP)、心功能分级均为CHF患者发生终点事件的影响因素(P<0.05)。血清MR-ProADM、Gal-3、GDF-15均对是否发生终点事件有一定预测价值,且三者联合检测时预测是否发生终点事件的曲线下面积(AUC)高于单独检测。结论 血清MR-ProADM、Gal-3、GDF-15可以作为诊断CHF和评估CHF患者预后的新型生物标志物,三者对提高CHF早期诊断准确率、指导危险分层及预测患者预后均有一定价值。

Objective To analyze the expression and clinical significance of mid-regional pro-adrenomedullin(MR-ProADM),galectin-3(Gal-3) and growth differentiation factor-15(GDF-15) in patients with chronic heart failure(CHF).Methods From May 2019 and July 2020,110 patients with CHF treated in the hospital were selected as CHF group,and another 40 patients hospitalized with essential hypertension or arrhythmia during the same period were enrolled as control group.The serum MR-ProADM,Gal-3 and GDF-15 were detected.According to the New York Heart Association(NYHA) cardiac functional grading,the patients in the CHF group were divided into groups A(grade Ⅱ),B(grade Ⅲ) and C(grade Ⅳ).The differences of the above indicators were compared among the three groups of patients.The patients were classified as event group and non-event group according to whether the end-point events(readmission for heart failure or all-cause death) occurred during 1 year of follow-up or not.Univariate analysis and multivariate Logistic regression analysis were used to screen out the risk factors of end-point events in patients with CHF.Receiver operating characteristic(ROC) curve was used to analyze the value of MR-ProADM,Gal-3 and GDF-15 in evaluating the prognosis of patients with CHF.Results The levels of serum MR-ProADM,Gal-3 and GDF-15 in CHF group were higher than those in control group(P<0.05).The expression levels of serum MR-ProADM,Gal-3 and GDF-15 in group B and group C were higher than those in group A(P<0.05),and the expression level of Gal-3 was significantly higher in group C than that in group B(P<0.05).During 1 year of follow-up,a total of 36 patients(32.73%) had end-point events.The levels of MR-ProADM,Gal-3 and GDF-15 in event group were higher compared with those in non-event group(P<0.05).Multivariate Logistic analysis showed that MR-ProADM,Gal-3,GDF-15,age,brain natriuretic peptide(BNP) and cardiac functional grading were the risk factors for end-point events in patients with CHF(P<0.05).Serum MR-ProADM,Gal-3 and GDF-15 had certain predictive value for the occurrence of end-point events,and the AUC of the combined detection was higher than that of single detection.Conclusion Serum MR-ProADM,Gal-3 and GDF-15 could be used as new biomarkers for the diagnosis of CHF and prognosis in patients with CHF.The three indicators have certain value in improving the accuracy of early diagnosis,guiding the risk stratification and predicting the prognosis of patients with CHF.