血清syndecan-1、Ficolin-3水平与心力衰竭患者心功能及预后的关系

The relationship between serum syndecan-1 and Ficolin-3 levels and cardiac function and prognosis in patients with heart failure

目的 探讨血清多配体蛋白聚糖1(syndecan-1)、纤维胶凝蛋白-3(Ficolin-3)水平与心力衰竭(HF)患者心功能及预后的关系。方法 选择2019年1月—2021年1月河北省沧州市人民医院心内科收治HF患者109例(HF组),根据纽约心脏病协会(NYHA)分级分为Ⅱ级亚组35例、Ⅲ级亚组46例、Ⅳ级亚组28例,另选择医院同期体检健康志愿者60例为健康对照组。检测受试者血清syndecan-1、Ficolin-3、脑钠肽(BNP)、N末端脑钠肽前体(NT-proBNP)水平,超声心动图检测左心房内径(LA)、左心室舒张末期内径(LVEDD)、左心室后壁厚度(LVPWT)、左心室射血分数(LVEF),随访患者出院后终点事件发生情况。Pearson分析血清syndecan-1、Ficolin-3与BNP、NT-proBNP、LA、LVEDD、LVPWT、LVEF的相关性,Logistic回归分析影响HF患者预后的相关因素,受试者工作特征曲线(ROC)分析血清syndecan-1、Ficolin-3预测HF患者预后的价值。结果 HF组血清syndecan-1、Ficolin-3水平高于健康对照组(t/P=39.469/<0.001、12.086/<0.001)。血清syndecan-1、Ficolin-3、BNP、NT-proBNP水平及LVEDD、LA、LVPWT比较,Ⅳ级亚组>Ⅲ级亚组>Ⅱ级亚组(F/P=82.230/<0.001、113.225/<0.001、116.335/<0.001、183.528/<0.001、247.916/<0.001、84.451/<0.001、163.446/<0.001),LVEF比较Ⅳ级亚组<Ⅲ级亚组<Ⅱ级亚组(F/P=57.157/<0.001)。血清syndecan-1、Ficolin-3与BNP、NT-proBNP、LVEDD、LVPWT、LA呈正相关(syndecan-1:r/P=0.326/0.010、0.419/<0.001、0.282/0.029、0.256/0.021、0.202/0.035;Ficolin-3:r/P=0.302/0.015、0.374/0.002、0.253/0.023、0.209/0.030、0.283/0.027),与LVEF呈负相关(r/P=-0.336/0.005,-0.402/<0.001)。血清NT-proBNP、syndecan-1、Ficolin-3升高是HF患者预后不良的危险因素[OR(95%CI)=2.724(1.620~4.579)、2.024(1.408~2.908)、1.842(1.323~2.566)]。血清syndecan-1、Ficolin-3及二者联合预测HF患者预后的曲线下面积分别为0.762、0.789、0.925,二者联合高于各自单独预测(Z/P=4.008/<0.001、3.562/0.003)。结论 HF患者血清syndecan-1、Ficolin-3水平升高,且与HF患者心功能下降及预后不良的发生有关。

Objective To investigate the relationship between serum syndecan-1(syndecan-1)and ficolin-3(Ficolin-3)levels and cardiac function and prognosis in patients with heart failure(HF).Methods Selected from January 2019 to January 2021 in the Department of Cardiology,Cangzhou People's Hospital,Hebei Province,109 patients with HF(HF group),who were divided into grade II subgroup 35 cases and grade III subgroup according to the New York Heart Association(NYHA)classification 46 cases,28 cases in the grade IV subgroup,and 60 healthy volunteers who underwent physical examination in the hospital during the same period were selected as the healthy control group.The serum levels of syndecan-1,Ficolin-3,B-type natriuretic peptide(BNP),and N-terminal B-type natriuretic peptide precursor(NT-proBNP)was detected.Echocardiography was used to detect left atrial diameter(LA),left ventricular end-diastolic Internal diameter(LVEDD),left ventricular posterior wall thickness(LVPWT),left ventricular ejection fraction(LVEF),and the occurrence of end-point events after discharge.Pearson analyzed the correlation of serum syndecan-1,Ficolin-3 with BNP,NT-proBNP,LA,LVEDD,LVPWT,LVEF,Logistic regression analysis of the related factors affecting the prognosis of HF patients,receiver operating characteristic curve(ROC)analysis of serum syndecan-1,Value of Ficolin-3 in predicting prognosis in HF patients.Results The serum levels of syndecan-1 and Ficolin-3 in HF group were higher than those in healthy control group(t/P=39.469/<0.001,12.086/<0.001).Comparison of serum syndecan-1,Ficolin-3,BNP,NT-proBNP levels and LVEDD,LA,LVPWT,grade IV subgroup>grade III subgroup>grade II subgroup(F/P=82.230/<0.001,113.225/<0.001,116.335/<0.001,183.528/<0.001,247.916/<0.001,84.451/<0.001,163.446/<0.001),LVEF was compared in grade IV subgroup<grade III subgroup<grade II subgroup(F/P=57.157/<0.001).Serum syndecan-1 and Ficolin-3 were positively correlated with BNP,NT-proBNP,LVEDD,LVPWT,and LA(syndecan-1:r/P=0.326/0.010,0.419/<0.001,0.282/0.029,0.256/0.021,0.202/0.035;Ficolin-3:r/P=0.302/0.015,0.374/0.002,0.253/0.023,0.209/0.030,0.283/0.027),which was negatively correlated with LVEF(r/P=-0.336/0.005,-0.402/<0.001).Elevated serum NT-proBNP,syndecan-1,and Ficolin-3 were risk factors for poor prognosis in HF patients[OR(95%CI)=2.724(1.620-4.579),2.024(1.408-2.908),1.842(1.323-2.566)].The areas under the curve of high serum syndecan-1,Ficolin-3 and their combination in predicting the prognosis of HF patients were 0.762,0.789,and 0.925,respectively,and the combination of the two was higher than that of their independent predictors(Z/P=4.008/<0.001、3.562/0.03).Conclusion Serum levels of syndecan-1 and Ficolin-3 in HF patients are elevated,and they are associated with the decline of cardiac function and poor prognosis in HF patients.