外周血CⅠCP、NLR及鸢尾素在心房颤动合并心力衰竭患者中的表达及诊断价值

Expression and diagnostic value of CⅠCP,NLR and irisin in peripheral blood in patients with atrial fibrillation complicated with heart failure

目的探讨外周血Ⅰ型前胶原C末端肽(CⅠCP)、中性粒细胞淋巴细胞比值(NLR)及鸢尾素在心房颤动合并心力衰竭患者中的表达及诊断价值。方法选取2018年2月至2020年2月该院收治的心房颤动合并心力衰竭住院患者310例作为研究对象(A组),另选取同期在该院住院的心房颤动不合并心力衰竭(B组)、无心房颤动和心力衰竭(C组)患者各100例作为对照组。分别检测3组血清脑钠肽(BNP)、CⅠCP、鸢尾素、左室射血分数(LVEF)、NLR。Pearson相关性分析各指标间的相关性,绘制受试者工作特征曲线(ROC曲线)评价各指标的灵敏度和特异度。结果A组CⅠCP、NLR水平均高于B、C组,差异有统计学意义(P<0.05);A组鸢尾素水平低于B、C组,差异有统计学意义(P<0.05)。CⅠCP与BNP呈正相关(r=0.119,P<0.05),与LVEF呈负相关(r=-0.126,P<0.05);NLR与BNP呈正相关(r=0.122,P<0.05),与LVEF呈负相关(r=-0.131,P<0.05);鸢尾素与BNP呈负相关(r=-0.462,P<0.05),与LVEF呈正相关(r=0.685,P<0.05)。CⅠCP、NLR、鸢尾素诊断心房颤动合并心力衰竭灵敏度分别为64.50%、66.50%、71.00%,特异度分别为90.00%、93.00%、75.00%。CⅠCP、NLR、鸢尾素联合诊断的灵敏度和特异度分别为90.30%、60.00%。ROC曲线分析显示,CⅠCP、NLR、鸢尾素及联合诊断心房颤动合并心力衰竭的曲线下面积分别为0.902(95%CI:0.870~0.934)、0.997(95%CI:0.993~1.000)、0.731(95%CI:0.661~0.801)、0.998(95%CI:0.995~1.000),差异有统计学意义(P<0.05)。结论CⅠCP、NLR、鸢尾素可以用于心房颤动合并心力衰竭的辅助诊断,具有较高的灵敏度、特异度和准确度。

Objective To investigate the expression and diagnostic value of typeⅠprocollagen C terminal peptide(CⅠCP),neutrophil lymphocyte ratio(NLR)and irisin in peripheral blood in patients with atrial fibrillation complicated with heart failure.Methods 310 patients with atrial fibrillation complicated with heart failure admitted to a hospital from February 2018 to February 2020 were selected as research objects(group A),and 100 patients with atrial fibrillation without heart failure(group B),without atrial fibrillation and heart failure(group C)in this hospital were selected as control group during the same period.Serum brain natriuretic peptide(BNP),CⅠCP,irisin,left ventricular ejection fraction(LVEF)and NLR were detected.Pearson correlation analysis of the correlation between each index,draw the receiver operating characteristic curve(ROC curve)to evaluate the sensitivity and specificity of each index.Results The levels of CⅠCP and NLR in group A were higher than those in group B and C,with statistical significance(P<0.05).The level of irisin in group A was lower than that in group B and C,and the difference was statistically significant(P<0.05).CⅠCP was positively correlated with BNP(r=0.119,P<0.05),and negatively correlated with LVEF(r=-0.126,P<0.05).NLR was positively correlated with BNP(r=0.122,P<0.05)and negatively correlated with LVEF(r=-0.131,P<0.05).Irisin was negatively correlated with BNP(r=-0.462,P<0.05)and positively correlated with LVEF(r=0.685,P<0.05).The sensitivity of CⅠCP,NLR and irisin in the diagnosis of atrial fibrillation complicated with heart failure were 64.50%,66.50%and 71.00%,and the specificity was 90.00%,93.00%and 75.00%,respectively.The sensitivity and specificity of combined diagnosis of CⅠCP,NLR and irisin were 90.30%and 60.00%,respectively.ROC curve analysis showed that the area under the curve of CⅠCP,NLR,irisin and combined diagnosis of atrial fibrillation with heart failure were 0.902(95%CI:0.870—0.934),0.997(95%CI:0.993—1.000),0.731(95%CI:0.661—0.801),0.998(95%CI:0.995—1.000),the difference was statistically significant(P<0.05).Conclusion CⅠCP,NLR and Irisin can be used in the auxiliary diagnosis of AF combined with heart failure,with high sensitivity,specificity and accuracy.