不同NYHA分级慢性心力衰竭患者血清SIRT1、VS-2水平变化及其与疾病转归的关系

Changes of Serum SIRT1 and VS-2 Levels in Patients with Chronic HeartFailure with Different NYHA Grades and Their Relationship with Disease Outcome

目的观察不同美国纽约心脏病学会(NYHA)心功能分级慢性心力衰竭患者血清沉默信息调节因子2相关酶1(SIRT1)、血管形成抑制素-2(VS-2)水平变化及其与疾病转归的关系。方法选取2019年1月至2020年6月睢县中心医院收治的160例慢性心力衰竭患者为研究组,其中NYHA心功能分级Ⅱ级59例、Ⅲ级55例、Ⅳ级46例,并选取同期80例健康体检者为健康组,均检测血清VS-2、SIRT1水平,并进行超声心动图(UCG)检测,对比两组血清VS-2、SIRT1水平及UCG参数[左室射血分数(LVEF)、左室舒张末内径(LVEDD)、平均脉动压(MAP)、左室收缩末期内径(LVESD)],分析血清相关水平与UCG参数的相关性;随访6个月,根据慢性心力衰竭患者疾病转归预后情况分为预后良好组(92例)、预后不良组(68例),分析血清SIRT1、VS-2对预后良好的预测价值。结果研究组血清SIRT1、VS-2水平及LVEF均较健康组低,LVEDD、MAP、LVESD均较健康组高(P<0.05);NYHA心功能Ⅳ级患者血清SIRT1、VS-2及LVEDD、MAP、LVESD水平低于NYHA心功能Ⅲ级、Ⅱ级患者,LVEF高于NYHA心功能Ⅲ级、Ⅱ级患者,NYHA心功能Ⅲ级患者血清相关指标及LVEDD、MAP、LVESD水平较NYHA心功能Ⅱ级患者低(P<0.05)。患者血清SIRT1、VS-2与LVEF呈正相关,与LVESD、MAP、LVEDD呈负相关(P<0.05)。血清SIRT1、VS-2水平联合预测慢性心衰患者预后良好的AUC为0.913、灵敏度为91.18%、特异度为93.48%。结论血清SIRT1、VS-2水平是慢性心力衰竭患者心功能的敏感评价指标,其水平随心功能升高呈降低趋势,与患者疾病转归密切相关。

Objective To observe the changes of serum silent mating-type information regulation 2 homolog 1(SIRT1)and vasostatin-2(VS-2)levels in patients with chronic heart failure with different New York Heart Association(NYHA)cardiac function classes,and to analyze their relationship with disease outcome.Methods A total of 160 patients with chronic heart failure who were admitted to Suixian Central Hospital from January 2019 to June 2020 were selected as the research group,including 59 patients with NYHA cardiac function classⅡ,55 patients with classⅢ,and 46 patients with classⅣ,and 80 patients of the healthy subjects during the same period were selected as the healthy group.The serum VS-2 and SIRT1 levels of patients were detected,and ultrasonic cardiogram(UCG)was performed.The serum VS-2,SIRT1 levels and UCG parameters[left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),mean pulsatile pressure(MAP),left ventricular end systolic diameter(LVESD)]of patients were compared,and the correlations between serum related levels and UCG parameters were analyzed.After 6 months of follow-up,patients were divided into good prognosis group(92 cases)and poor prognosis group(68 cases)according to their disease outcomes.The predictive value of serum SIRT1 and VS-2 on good prognosis was analyzed.Results Serum levels of SIRT1,VS-2 and LVEF in the study group were lower than those in the healthy group,while LVEDD,MAP and LVESD were higher than those in the healthy group(P<0.05).The serum levels of SIRT1,VS-2,LVEDD,MAP and LVESD in NYHA cardiac function classⅣpatients were lower than those in NYHA cardiac function classⅢandⅡpatients,and the LVEF was higher than that in NYHA cardiac function classⅢandⅡpatients.The levels of LVEDD,MAP and LVESD were lower in NYHA cardiac function classⅢpatients than those in NYHA classⅡcardiac function patients(P<0.05).Serum SIRT1 and VS-2 were positively correlated with LVEF,and was negatively correlated with LVESD,MAP,LVEDD(P<0.05).The AUC value of serum SIRT1 and VS-2 levels combined to predict the disease outcome of patients with chronic heart failure was 0.913,the sensitivity was 91.18%,and the specificity was 93.48%.Conclusion The levels of serum SIRT1 and VS-2 are sensitive serum indicators for evaluating cardiac function in patients with chronic heart failure.The levels of SIRT1 and VS-2 tend to decrease with the increase of cardiac function,which are closely related to the disease outcome of patients.