血清肌肉生长抑制素在老年严重失代偿期急性心力衰竭患者预后评估中的价值

The prognostic value of serum myostatin in elderly patients with severe decompensated acute heart failure

目的:探讨血清肌肉生长抑制素(myostatin)在老年严重失代偿期急性心力衰竭(AHF)患者预后评估中的价值。方法:选取2015年6月—2019年1月期间收治的286例老年严重失代偿期AHF患者。入院24 h内采患者肘静脉血,用酶联免疫吸附试验检测myostatin水平,以中位数为截断值,将患者分为高表达组和低表达组。计算286例患者入院后180 d的存活率,进而将患者分为存活组和死亡组。绘制Kaplan-Meier曲线分析患者生存率,logistic回归分析影响患者死亡预后的因素;受试者工作特征曲线(ROC)分析myostatin预测患者死亡预后的价值。结果:286例患者入院后180 d时死亡54例,病死率为18.88%。286例患者的血清myostatin浓度为(12.18±4.08)ng/mL,中位数为10.27 ng/mL,高表达组患者的存活率明显低于低表达组,差异有统计学意义(P<0.05)。死亡组C反应蛋白(CRP)、B型脑钠肽(BNP)、N末端B型利钠肽原(NT-proBNP)和myostatin表达水平均高于存活组,差异有统计学意义(P<0.05)。Logistic多因素分析结果显示,CRP、BNP、NT-proBNP和myostatin是老年严重失代偿期AHF患者死亡的独立影响因素(P<0.05)。血清myostatin预测患者死亡的ROC曲线下面积为0.736,明显高于CRP(0.379)、BNP(0.625)和NT-proBNP(0.643)。结论:Myostatin对早期预测老年严重失代偿期AHF患者的死亡预后有一定价值。

Objective:To explore the value of serum myostatin in the prognosis of elderly patients with severe decompensated acute heart failure(AHF).Methods:From June 2015 to January 2019,286 elderly patients with severe decompensated AHF were selected.Within 24 hours after admission,the elbow vein blood was drawn and the myostatin level was detected by enzyme-linked immunosorbent assay.Patients were divided into high expression group and low expression group with median as cutoff value.The survival rate of 286 patients was calculated 180 days after admission,and then the patients were divided into survival group and death group.Kaplan-Meier curve was drawn to analyze the survival rate of patients;logistic regression was used to analyze the factors influencing the prognosis of patients;ROC curve was used to analyze the value of myostatin in predicting the prognosis of patients.Results:Two hundred and eighty-six patients died 180 days after admission,the mortality rate was 18.88%.The serum concentration of myostatin was(12.18±4.08)ng/mL,the median was 10.27 ng/mL,the survival rate of patients in the high expression group was significantly lower than that in the low expression group(P<0.05).The expression levels of CRP,BNP,NT-proBNP and myostatin in the dead group were higher than those in the living group(P<0.05).The results of logistic multivariate analysis showed that CRP,BNP,NT-proBNP and myostatin were the independent factors for death in elderly patients with severe decompensated AHF(P<0.05).The area under ROC curve(AUC)of serum myostatin was 0.736,which was significantly higher than CRP(AUC=0.379),BNP(AUC=0.625)and NT-proBNP(AUC=0.643).Conclusion:Myostatin has a certain value in predicting the prognosis of elderly AHF patients in severe decompensation.