正五聚蛋白3和心型脂肪酸结合蛋白及肌酸激酶同工酶水平与慢性心力衰竭患者治疗效果的关系及对心血管事件发生的预测研究

The relationship between the levels of PTX3, H-FABP and CK-MB and the therapeutic effect in patients with chronic heart failure and the prediction of cardiovascular events

目的 观察慢性心力衰竭(CHF)患者血清中正五聚蛋白3(PTX3)、人心肌脂肪酸结合蛋白(HFABP)、肌酸激酶同工酶(CK-MB)表达水平变化,分析其在CHF诊断、心功能不全严重程度和心血管事件发生预测中的价值。方法 前瞻性纳入2018年7月至2019年11月入邢台市第三医院心内科诊疗的75例CHF患者作为慢性心衰组,另选取同期75名健康体检者作为健康对照组。检测两组血清PTX3、H-FABP、CK-MB、NT-ProBNP的水平;分析PTX3、H-FABP、CKMB水平之间的相关性及其与患者心功能指标的关系;ROC曲线分析单独诊断与联合诊断的价值。跟踪随访3个月,根据心血管事件发生情况将患者进行分组,分析PTX3、H-FABP、CK-MB水平与患者心血管事件的关系。结果 两组患者在年龄、性别、BMI、吸烟、糖尿病以及高血脂症的一般资料无统计学差异(P>0.05);与健康对照组相比,慢性心衰组的PTX3、H-FABP、CK-MB水平明显升高,且随着NYHA心功能分级的升高,慢性心衰组患者的PTX3、H-FABP、CK-MB、NTProBNP水平也明显升高(P<0.05);CHF患者血清PTX3水平与H-FABP、CK-MB的水平呈显著正相关(r=0.561、0.632,均P<0.05);H-FABP的阳性预测值高于PTX3、CK-MB(P<0.05);H-FABP的Youden指数高于PTX3、CK-MB;H-FABP、H-FABP与CK-MB的阴性预测值相似,但低于联合检测;PTX3、H-FABP、CK-MB与心输出量、心脏指数、射血分数呈负相关。PTX3、H-FABP、CK-MB单独诊断的曲线下面积为0.751、0.793、0.821,低于联合诊断的0.942,且诊断的敏感性高于单独检测组(P<0.05)。发生心血管事件的慢性心衰患者组的血清PTX3、H-FABP、CK-MB水平明显高于未发生心血管事件的患者,有统计学差异(P<0.05)。结论CHF患者血清PTX3、H-FABP、CK-MB水平明显升高,通过监测血液中的PTX3、H-FABP、CK-MB数值的变化,可及时反映患者疾病的严重程度和近期心血管事件发生情况。

Objective To observe the expression levels of PTX3, H-FABP and CKMB in serum of patients with chronic heart failure(CHF), and analyze their value in the diagnosis of CHF, the severity of cardiac insufficiency and the prediction of cardiovascular events. Methods From July 2018 to November 2019, a total of75 patients with CHF admitted to the Department of Cardiology of Xingtai Third Hospital were prospectivelyincluded as the chronic heart failure group, and 75 healthy people in the same period were selected as the healthy control group. The levels of serum PTX3, H-FABP, CK-MB and NT pro BNP were detected in the two groups;The correlation between PTX3, H-FABP and CKMB levels and their relationship with cardiac function indexes were analyzed;The value of ROC curve analysis in separate diagnosis and combined diagnosis. The patients were followed up for 3 months. The patients were grouped according to the occurrence of cardiovascular events, and the relationship between the levels of PTX3, H-FABP and CK-MB and cardiovascular events was analyzed. Results There was no significant difference in age, gender, BMI, smoking, diabetes and hyperlipidemia between the two groups(P>0.05). Compared with the healthy control group, the levels of PTX3, H-FABP, CK-MB in the chronic heart failure group increased significantly, and with the increase of NYHA cardiac function grade, the levels of PTX3, H-FABP, CK-MB and NT pro BNP in the chronic heart failure group also increased significantly(P<0.05);There was a significant positive correlation between the level of serum PTX3 and the levels of H-FABP and CKMB in patients with CHF(r=0.561, 0.632, all P<0.05);The positive predictive value of H-FABP was higher than that of PTX3 and CK-MB(P<0.05);The Youden index of H-FABP was higher than that of PTX3 and CK-MB;The negative predictive values of H-FABP, H-FABP and CK-MB were similar, but lower than those of combined detection;PTX3, H-FABP and CK-MB were negatively correlated with cardiac output, cardiac index and ejection fraction. The areas under the curve of PTX3, H-FABP and CK-MB diagnosed separately were 0.751, 0.793 and0.821, which were lower than 0.942 of combined diagnosis, and the sensitivity of diagnosis was higher than that of single detection group(P<0.05). The levels of serum PTX3, H-FABP and CK-MB in patients with chronic heart failure with cardiovascular events were significantly higher than those without cardiovascular events(P<0.05).Conclusion The levels of serum PTX3, H-FABP and CK-MB in patients with CHF are significantly increased.Monitoring the changes of PTX3, H-FABP and CK-MB in blood can timely reflect the severity of disease and recent cardiovascular event.