血清可溶性Fas及其配体对慢性心力衰竭患者心力衰竭严重程度的预测价值

Predictive value of serum soluble Fas and its ligand for heart failure severity in patients with chronic heart failure

目的探讨血清可溶性Fas(sFas)及其配体(sFasL)对慢性心力衰竭(CHF)患者心力衰竭严重程度的预测价值。方法将89例CHF患者根据心功能分级分为轻度心力衰竭组(心功能Ⅱ级,n=32)和重度心力衰竭组(心功能Ⅲ~Ⅳ级,n=57)。比较两组患者的一般临床资料和血清sFas水平、sFasL水平、N末端B型利钠肽原水平(NT-proBNP),并分析血清sFas、sFasL水平与NT-proBNP水平的相关性,采用受试者工作特征(ROC)曲线分析血清sFas、sFasL水平与CHF患者心力衰竭严重程度的关系。结果重度心力衰竭组的血清sFas、sFasL水平较轻度心力衰竭组升高(均P<0.05);血清sFas、sFasL水平均与血清NT-proBNP水平呈正相关性(均P<0.05);二分类Logistic回归分析结果显示,血清sFas、sFasL水平与CHF患者心力衰竭严重程度相关(均P<0.05);ROC曲线分析结果显示,血清sFas、sFasL水平预测CHF患者心力衰竭严重程度的曲线下面积分别为0.825、0.752,两者联合预测的曲线下面积为0.876。其中血清sFas水平、血清sFas水平联合sFasL水平预测CHF患者心力衰竭严重程度的灵敏度均高于血清sFasL水平(均P<0.05)。结论血清sFas、sFasL水平对CHF患者心力衰竭严重程度有一定的预测价值,二者联合预测的效能更高。

Objective To investigate the predictive value of serum soluble Fas(sFas)and its ligand(sFasL)for the severity of heart failure in patients with chronic heart failure(CHF).Methods Eighty-nine CHF patients were divided into mild heart failure group(gradeⅡcardiac function,n=32)and severe heart failure(gradeⅢ-Ⅳcardiac function,n=57)according to the grade of cardiac function.The general clinical data as well as the serum levels of sFas,sFasL,and N-terminal pro-B-type natriuretic peptide(NT-proBNP)were compared between the two groups.In addition,the correlations of serum sFas and sFasL levels with NT-proBNP level were analyzed,and the receiver operating characteristic(ROC)curve was employed to analyze the relationships of serum sFas and sFasL levels with the severity of heart failure in CHF patients.Results The severe heart failure group exhibited elevated serum levels of sFas and sFasL than the mild heart failure group(all P<0.05);both serum sFas and sFasL levels positively correlated with serum NT-proBNP level(all P<0.05).The results of binary Logistic regression analysis showed that serum sFas and sFasL levels correlated with the severity of heart failure in CHF patients(all P<0.05).The results of ROC curve analysis showed that,for predicting the severity of heart failure in CHF patients,serum sFas and sFasL levels yielded the areas under the curves of 0.825 and 0.752,respectively,and their combination yielded an area under the curve of 0.867.Both serum sFas level and serum sFas level combined with sFasL level yielded higher sensitivities than serum sFasL level for predicting the severity of heart failure in CHF patients(all P<0.05).Conclusion Both serum sFas and sFasL levels have certain predictive value for the severity of heart failure in CHF patients,and their combination achieves higher predictive efficacy.