Periostin蛋白在心力衰竭合并心房颤动患者血清中的表达及其诊断预后价值

Expression of Periostin protein in serum of patients with heart failure complicated and atrial fibrillation and its diagnostic and prognostic value

目的探讨Periostin蛋白在心力衰竭合并心房颤动患者血清中的表达水平及其诊断预后价值。方法将安徽省阜阳市第二人民医院于2020年9月~2021年5月收治的212例心力衰竭患者作为研究对象,根据患者是否合并心房颤动分为合并心房颤动组(HF-AF)计110例,及窦性心律组(HF-SR)计102例。比较两组血清Periostin蛋白表达水平,采用受试者工作特征(ROC)曲线分析血清Periostin蛋白表达水平的诊断价值,并采用COX风险模型进行预后分析。结果与HF-SR组比较,HF-AF组患者合并冠心病比例数值低,总胆红素、γ-谷氨酰基转肽酶、血小板计数、血红蛋白、脑钠肽、血清Periostin蛋白数值均升高。差异具有统计学意义(均P<0.01)。Pearson相关分析显示,HF-SR组中Periostin水平与舒张压(P<0.05)、NYHA分级(P<0.05)、脑钠肽(P<0.01)呈正相关,与LVEF(P<0.05)呈负相关性。HF-AF组中,Periostin与舒张压(P<0.05)、高血压(P<0.05)、NYHA分级(P<0.05)、脑钠肽(P<0.01)、谷丙转氨酶(P<0.05)、γ-谷氨酰转肽酶(P<0.05)、脑钠肽(P<0.01)呈正相关,与LVEF(P<0.01)、eGFR(P<0.01)呈负相关;ROC曲线在临界值为42.53 ng/L时Periostin诊断HF-SR的AUC为0.721(0.666~0.785),敏感度、特异度分别为70.69%、77.98%,Periostin诊断HF-AF的AUC为0.847(0.789~0.902),临界值为46.33 ng/L,敏感度、特异度分别为85.34%、83.21%。Hanley-McNeil分析显示诊断HFAF的AUC明显高于诊断HF-SR(P<0.05)。血清Periostin水平(OR=2.358,95%CI为1.058~4.827)、NYHAⅢ/Ⅳ(OR=1.925,95%CI为1.016~3.725)、BNP(OR=2.012,95%CI为1.052~3.862)为HF患者再住院或心血管死亡事件的危险因素。血清Periostin<48.82 ng/L患者无事件生存率高于血清Periostin≥48.82 ng/L患者(P<0.05)。HF-AF血清Periostin水平≥52.26 ng/L(OR=1.864,95%CI为1.026~3.854)是HF-AF患者再住院或心血管死亡事件的危险因素(P<0.05),血清Periostin水平<52.26 ng/L的患者无事件生存率高于血清Periostin≥52.26 ng/L的患者(P<0.05)。结论HF-AF患者血清Periostin水平高于HF-SR患者,是影响疾病预后的独立危险因素,且Periostin诊断HF-AF患者价值明显高于HF-SR患者。

AIM To investigate the expression level of periodin protein in serum of patients with heart failure complicated with atrial fibrillation and its diagnostic and prognostic value.METHODS 212 patients with heart failure treated in the Second People’s Hospital of Fuyang City,Anhui Province from September 2020 to may 2021 were studied,Patients were divided into heart failure with atrial fibrillation(HF-AF)group(110 cases)and heart failure with sinus rhythm(HF-SR)group(102 cases)according to whether they were complicated with atrial fibrillation receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of serum periodin protein expression level,and COX risk model was used for prognosis analysis.RESULTS Compared with HF-SR group,the proportion of patients with coronary heart disease in HF-AF group was lower,total bilirubinγ-Glutamyl transpeptidase,platelet count,hemoglobin,Glomerular filtration rate(EGFR),brain natriuretic peptide(BNP)and serum Periostin protein increased significantly(all P<0.01).Pearson correlation analysis showed that the level of periodin in hf-sr group was positively correlated with diastolic blood pressure(P<0.05),NYHA grade(P<0.05)and brain natriuretic peptide(P<0.01),and negatively correlated with LVEF(P<0.05).In hf-af group,periodin and diastolic blood pressure(P<0.05),hypertension(P<0.05),NYHA grade(P<0.05),brain natriuretic peptide(P<0.01),alanine aminotransferase(P<0.05)γ-Glutamyltranspeptidase(P<0.05)and brain natriuretic peptide were positively correlated(P<0.01),and negatively correlated with LVEF(P<0.01)and EGFR(P<0.01),When the critical value of ROC curve was 42.53 ng/L,the AUC of periodin in the diagnosis of HF-SR was 0.721(0.666~0.785),the sensitivity and specificity were 70.69%and 77.98%respectively,and the AUC of periodin in the diagnosis of HF-AF was 0.847(0.789~0.902),the critical value was 46.33 ng/L,the sensitivity and specificity were 85.34%and 83.21%respectively.Hanley McNeil analysis showed that the AUC for the diagnosis of HF-AF was significantly higher than that for the diagnosis of HF-SR(P<0.05)(OR=2.012,95%CI 1.052~3.862)was a risk factor for rehospitalization or cardiovascular death in patients with HF.The event free survival rate of patients with serum periodin<48.82 ng/L was higher than that of patients with serum periodin≥48.82 ng/L(P<0.05).The serum periodin level of HF-AF≥52.26 ng/L(OR=1.864,95%CI 1.026~3.854)was a risk factor for rehospitalization or cardiovascular death in patients with HF-AF(P<0.05),the event free survival rate of patients with serum periodin level<52.26 ng/Lwas higher than that of patients with serum periodin≥52.26 ng/L(P<0.05).CONCLUSION The level of serum periodin in patients with HF-AF is higher than that in patients with HF-SR,which is an independent risk factor affecting the prognosis of the disease,and the value of periodin in the diagnosis of patients with HF-AF is significantly higher than that in patients with HF-SR.