IL-27、Treg/Th17对扩张型心肌病心力衰竭患者1年预后的预测价值

Clinical study of IL-27 and Treg/Th17 changes in predicting the 1-year prognosis of dilated cardiomyopathy and heart failure

目的 探讨扩张型心肌病(DCM)心力衰竭患者白细胞介素(IL)-27、调节性T细胞(Treg)/辅助性T细胞17(Th17)动态变化及其对1年预后的预测价值。方法 选取2018年3月至2020年5月该院收治的117例DCM心力衰竭患者,根据1年内预后分为病死组、存活组。比较两组基线资料和入院时、3个月后、6个月后IL-27、Treg、Th17、Treg/Th17水平,采用Cox回归分析预后的相关影响因素,采用受试者工作特征(ROC)曲线及曲线下面积(AUC)分析3个月后、6个月后IL-27、Treg、Th17、Treg/Th17对预后的预测价值,采用Kaplan-Meier生存曲线进行生存分析。结果 病死组美国纽约心脏病协会(NYHA)分级与存活组比较,差异有统计学意义(P<0.05);两组3个月后、6个月后IL-27、Treg、Treg/Th17水平均较入院时降低(P<0.05),Th17水平均较入院时升高(P<0.05);病死组3个月后、6个月后IL-27、Treg、Treg/Th17水平低于存活组(P<0.05),Th17水平高于存活组(P<0.05);将NYHA分级控制后,DCM心力衰竭患者3个月后、6个月后IL-27、Treg、Th17、Treg/Th17均是预后的相关影响因素(P<0.05);6个月后各指标预测预后的AUC大于3个月后对应指标的AUC,6个月后各指标联合预测预后的AUC最大;IL-27、Treg/Th17高危患者生存率低于低危患者(P<0.05)。结论 DCM心力衰竭患者IL-27、Treg、Th17、Treg/Th17动态变化与1年预后情况有关,联合检测可作为预测预后的一个有效方案,并有望成为防治患者不良预后新的干预靶点。

Objective To investigate the dynamic changes of interleukin(IL)-27,regulatory T cells(Treg)/helper T cell 17(Th17) in patients with dilated cardiomyopathy(DCM) and heart failure, and to investigate predict value for the one-year prognosis.Methods A total of 117 patients with DCM and heart failure admitted to the hospital from March 2018 to May 2020 were divided into death group and survival group according to the prognosis within 1 year.The baseline data and the levels of IL-27,Treg, Th17,Treg/Th17 at admission, 3 months and 6 months after admission of the two groups were compared.Cox regression analysis was used to analyze the prognostic factors, and the receiver operating characteristic(ROC) curve and area under the curve(AUC) were used to analyze the predictive value of IL-27,Treg, Th17 and Treg/Th17 on prognosis at 3 months and 6 months after admission, and the Kaplan-Meier curve was used for survival analysis.Results The New York Heart Association(NYHA) classification of the death group was compared with that of the survival group, and the difference was statistically significant(P<0.05);the levels of IL-27,Treg, Treg/Th17 were lower in the two groups at 3 months and 6 months after admission(P<0.05),the level of Th17 was higher than that of at admission(P<0.05);the levels of IL-27,Treg, Treg/Th17 in the death group were lower than the survival group at 3 months and 6 months after admission(P<0.05),and the level of Th17 was higher than that of the survival group(P<0.05);after NYHA classification control, IL-27,Treg, Th17,Treg/Th17 were all related prognostic factors at 3 months and 6 months after admission(P<0.05);at 6 months after admission, the AUC of indicators for predicting prognosis were greater than AUC of the corresponding indicators at 3 months after admission;the survival rate of IL-27 and Treg/Th17 high-risk patients were lower than those of low-risk patients(P<0.05).Conclusion The dynamic changes of IL-27 and Treg/Th17 in patients with DCM and heart failure are related to the one-year prognosis.Combined detection can be used as an effective prognosis prediction program, and is expected to become a new intervention target for the prevention and treatment of patients with poor prognosis.