老年慢性心力衰竭患者血清suPAR、PAI-1表达与预后的相关性研究

Correlation between expressions of serum suPAR and PAI-1 and prognosis in elderly patients with chronic heart failure

目的通过检测老年慢性心力衰竭(心衰)患者血清中可溶性尿激酶型纤溶酶原激活物受体(suPAR)、纤溶酶原激活物抑制因子(PAI-1)表达,解析其与老年慢性心衰病情及预后的关系。方法选取2018年1月至2020年1月于辽宁中医药大学附属医院确诊的老年慢性心衰患者120例为心衰组,同时根据NYHA分级分为Ⅱ、Ⅲ、Ⅳ级三个亚组,另选取同期健康体检者70例为对照组。采用酶联免疫吸附实验(ELISA)测定并比较各组老年慢性心衰患者及对照组血清suPAR、PAI-1、N末端脑钠肽前体(NT-proBNP)表达水平。根据患者1年内主要不良心血管事件(MACE)发生情况分为预后良好组和预后不良组,比较两组间血清suPAR和PAI-1水平。受试者工作特征曲线(ROC)测定血清suPAR、PAI-1对患者不良预后的诊断价值,多因素Logistic回归分析影响老年慢性心衰患者MACE发生的危险因素。结果与对照组相比,心衰组患者NT-proBNP、左室射血分数(LVEF)、左心室舒张末内径(LVEDD)、血清suPAR、PAI-1水平显著升高(P<0.05);随着NYHA分级的升高,老年慢性心衰患者血清中suPAR、PAI-1表达水平逐渐升高(P<0.05);与预后良好组相比,预后不良组老年慢性心衰患者NTproBNP、LVEF、LVEDD、血清suPAR、PAI-1表达水平显著升高(P<0.05)。随访结果显示,发生预后不良老年慢性心衰患者48例,ROC曲线结果显示,血清suPAR、PAI-1表达水平诊断老年慢性心衰患者不良预后曲线下面积(AUC)为0.836(95%CI:0.758~0.914)、0.757(95%CI:0.662~0.853);多因素Logistic回归分析显示NT-proBNP、LVEF、LVEDD、血清suPAR、PAI-1水平为患者发生预后不良的危险因素(P<0.05)。结论老年慢性心力衰竭患者血清中suPAR、PAI-1水平随着病情严重程度增加而增加,是老年慢性心衰患者不良预后的危险因素,具有一定临床诊断价值。

Objective To analyze the relationship among serum soluble urokinase plasminogen activator receptor(suPAR)and plasminogen activator inhibitors-1(PAI-1),conditions and prognosis in elderly patients with chronic heart failure(CHF)through detecting expressions of suPAR and PAI-1.Methods CHF patients(n=120)were chosen into heart failure group(HF group)from the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from Jan.2018 to Jan.2020,and at the same time,HF group was divided,according to NYHA classification,into gradeⅡsubgroup,gradeⅢsubgroup and gradeⅣsubgroup.Meanwhile the controls with healthy examination(n=70)were chosen into control group.The expressions of suPAR,PAI-1 and N-terminal probrain natriuretic peptide(NT-proBNP)were detected by using ELISA in all groups.The patients were divided,according to incidence of major adverse cardiovascular events(MACE)within 1 y,into good prognosis group and poor prognosis group,and levels of serum suPAR and PAI-1 were compared between 2 groups.The diagnostic value of suPAR and PAI-1 to poor prognosis was detected by using ROC curve,and risk factors of MACE were analyzed by using multi-factor Logistic regression analysis in elderly CHF patients.Results The levels of NT-proBNP,left ventricular ejection fraction(LVEF)and left ventricular end-diastolic inner diameter(LVEDD),and expressions of serum suPAR and PAI-1 increased significantly in HF group compared with control group(P<0.05).As the increases of NYHA grades,the expressions of serum suPAR and PAI-1 increased(P<0.05).The levels of NTproBNP,LVEF and LVEDD and expressions of serum suPAR and PAI-1 increased significantly in poor prognosis group compared with good prognosis group(P<0.05).The results of follow-up showed that there were 48 elderly CHF patients with poor prognosis.The results of ROC curve analysis showed that the area under the curve(AUC)of suPAR was 0.836(95%CI:0.758~0.914)and AUC of PAI-1 was 0.757(95%CI:0.662~0.853)in diagnosis of poor prognosis in elderly CHF patients.The multi-factor Logistic regression analysis showed that the levels of NTpro BNP,LVEF and LVEDD and expressions of serum suPAR and PAI-1 were risk factors of poor prognosis(P<0.05).Conclusion The expressions of serum suPAR and PAI-1 will increase as the severity of CHF condition increases,which are risk factors of poor prognosis with some clinical diagnostic value in elderly CHF patients.