血清相关蛋白与急性心力衰竭严重程度及心肌耗能的关系

Relationship between serum associated proteins with severity degree of acute heart failure and its myocardial energy consumption

目的 分析血清转化生长因子-β(TGF-β)、胰岛素样生长因子结合蛋白-7(IGFBP7)、Periostin蛋白与急性心力衰竭(AHF)患者病情严重程度及心肌能量消耗(MEE)间的关系,并研究其在预测AHF患者预后中的价值。方法 将该院2018年1月至2020年1月收治的105例AHF患者及同期到该院体检的50例体检健康者分别作为观察组与对照组,检测两组血清TGF-β、IGFBP7及Periostin蛋白水平,并分析以上血清指标与AHF患者心功能分级、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)及MEE间的相关性;随访6个月,统计AHF患者主要不良心血管事件发生情况,绘制受试者工作特征(ROC)曲线,分析血清TGF-β、IGFBP7及Periostin蛋白在预测不良心血管事件中的价值。结果 观察组患者血清TGF-β、IGFBP7、Periostin蛋白、NT-proBNP、MEE水平均明显高于对照组(P<0.05);心功能分级Ⅲ~Ⅳ级患者血清TGF-β、IGFBP7、Periostin蛋白水平均明显高于Ⅰ~Ⅱ级患者(P<0.05);LVEDD>70 mm组患者血清TGF-β、IGFBP7、Periostin蛋白水平均明显高于LVEDD≤70 mm组患者(P<0.05);LVEF≤40%组患者血清TGF-β、IGFBP7、Periostin蛋白水平均明显高于LVEF>40%组患者(P<0.05);AHF患者血清TGF-β、IGFBP7、Periostin蛋白与其心功能分级及NT-proBNP、LVEDD、MEE水平均呈正相关(r>0,P<0.05),与LVEF水平均呈负相关(r<0,P<0.05);预后不良组AHF患者血清TGF-β、IGFBP7、Periostin蛋白水平均显著高于预后良好组(P<0.05);绘制ROC曲线发现,血清TGF-β、IGFBP7及Periostin蛋白单独检测时,以IGFBP7预测不良心血管事件的效能最高,其曲线下面积(AUC)为0.856(95%CI:0.754~0.957),而3项指标联合检测的AUC为0.898(95%CI:0.797~1.000)。结论 血清TGF-β、IGFBP7、Periostin蛋白在评估AHF患者心力衰竭严重程度、左心室射血功能、结构改变及MEE中均具有良好的效果,且在预测不良心血管事件中也具有一定效能,有望成为AHF患者病情评估及预后判断的新型血清标志物。

Objective To analyze the relationship between serum transforming growth factor-β(TGF-β),insulin-like growth factor binding protein-7(IGFBP7)and Periostin protein with the severity degree of acute heart failure(AHF)and its myocardial energy expenditure(MEE),and to investigate their value in predicting the prognosis of AHF patients.Methods A total of 105 patients with AHF and 50 healthy volunteers undergoing physical examination at the same time in this hospital from January 2018 to January 2020 served as the observation group and control group respectively.The expression levels of serum TGF-β,IGFBP7 and Periostin protein were detected.The correlation between the above serum indicators with the cardiac function grade,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)and MEE in the patients with AHF was analyzed;all patients were followed up for 6 months,and the occurrence situation of major adverse cardiovascular events(MACE)was statistically analyzed.The receiver operating characteristic(ROC)curve was drawn.Then the value of serum TGF-β,IGFBP7 and Periostin protein in predicting the MACE was analyzed.Results The levels of serum TGF-β,IGFBP7,Periostin protein,NT-proBNP and MEE in the observation group were significantly higher than those in control group(P<0.05);the levels of serum TGF-β,IGFBP7 and Periostin protein in the patients of cardiac function gradeⅢ-Ⅳwere significantly higher than those in the patients of gradeⅠ-Ⅱ(P<0.05);serum TGF-β,IGFBP7 and Periostin protein levels in the patients with LVEDD>70 mm were significantly higher than those in the patients with LVEDD≤70 mm(P<0.05);serum TGF-β,IGFBP7,and Periostin protein levels in the patients with LVEF≤40%were significantly higher than those in the patients with LVEF>40%(P<0.05);serum TGF-β,IGFBP7 and Periostin proteins in AHF patients were positively correlated with the cardiac function grade,NT-proBNP,LVEDD and MEE levels(r>0,P<0.05),and negatively correlated with the LVEF levels(P<0.05);serum TGF-β,IGFBP7 and Periostin protein levels in the AHF patients with poor prognosis group were significantly higher than those in the good prognosis group(P<0.05);drawing the ROC curve found that when the serum TGF-β,IGFBP7 and Periostin protein single detection,the efficiency of IGFBP7 for predicting MACE was the highest,its area under the curve(AUC)was 0.856(95%CI:0.754-0.957),while AUC of 3-indicator combined detection was 0.898(95%CI:0.797-1.000).Conclusion Serum TGF-β,IGFBP7 and Periostin protein have good effects in assessing the severity degree of heart failure,left ventricular ejection function,structural changes and MEE in the patients with AHF,moreover have a certain efficiency in predicting MACE,which is expected to become the new type serum markers in the disease condition assessment and prognosis judgment of AHF patients.