血清Cys-C、TBiL、MR-proADM、AGEs与老年慢性心力衰竭患者心功能和心脏再同步化治疗应答的关系研究

Relationship Study between Serum Cys-C,TBiL,MR-proADM,AGEs and Cardiac Function and Response of Cardiac Resynchronization Therapy in Elderly Patients with Chronic Heart Failure

目的:探讨血清胱抑素C(Cys-C)、总胆红素(TBi L)、肾上腺髓质中段肽(MR-proADM)、晚期糖基化终末产物(AGEs)与老年慢性心力衰竭(CHF)患者心功能和心脏再同步化治疗(CRT)应答的关系。方法:选择2020年3月至2022年1月我院收治的151例接受CRT治疗的老年CHF患者为研究对象,随访6个月,统计治疗应答情况。CRT治疗前检测血清Cys-C、TBi L、MR-proADM、AGEs水平,超声心动图检测心功能,分析血清Cys-C、TBi L、MR-proADM、AGEs与心功能的相关性以及与老年CHF患者CRT治疗应答的关系。结果:151例患者失访1例,余150例患者中无应答48例(无应答组),应答102例(应答组)。无应答组血清Cys-C、TBi L、MR-proADM、AGEs水平均高于应答组(P<0.05),且与左心室射血分数(LVEF)呈负相关(P<0.05),与左室舒张末期内径(LVEDD)和左室收缩末期内径(LVESD)呈正相关(P<0.05)。多因素Logistic回归分析结果显示缺血性心肌病、血清Cys-C、TBi L、MR-proADM、AGEs是老年CHF患者CRT治疗无应答的危险因素(P<0.05),LVEF是保护因素(P<0.05)。结论:CRT治疗无应答老年CHF患者血清Cys-C、TBi L、MR-proADM、AGEs水平升高,且与心功能下降有关。血清Cys-C、TBi L、MR-proADM、AGEs是CRT治疗无应答的危险因素,可为CRT治疗效果评估提供一定的参考。

Objective:To investigate the relationship between serum cystatin C(Cys-C),total bilirubin(TBi L),mid-regional proadrenomedullin(MR-proADM),advanced glycosylated end products(AGEs)and cardiac function and response to cardiac resynchronization therapy(CRT)in elderly patients with chronic heart failure(CHF).Methods:From March 2020 to January 2022,151 elderly patients with CHF who received CRT treatment in our hospital were selected as the study subjects.They were followed up for 6 months and the treatment response was statistically analyzed.Before CRT treatment,the levels of serum Cys-C,TBi L,MR-proADM and AGEs were detected,and cardiac function was detected by echocardiography.The correlation between serum Cys-C,TBi L,MR-proADM and AGEs and cardiac function and the response to CRT treatment in elderly patients with CHF were analyzed.Results:1 cases of 151 patients was lost to follow-up,48 cases of the remaining 150 patients did not respond(non response group),and 102 patients responded(response group).The levels of serum Cys-C,TBi L,MR-proADM and AGEs in the non response group were higher than those in the response group(P<0.05),and they were negatively correlated with left ventricular ejection fraction(LVEF)(P<0.05),and positively correlated with left ventricular end diastolic diameter(LVEDD)and left ventricular end systolic diameter(LVESD)(P<0.05).Multivariate Logistic regression analysis showed that ischemic cardiomyopathy,serum Cys-C,TBi L,MR-proADM and AGEs were the risk factors of non response to CRT treatment in elderly patients with CHF(P<0.05),and LVEF was the protective factor(P<0.05).Conclusion:The levels of serum Cys-C,TBi L,MR-proADM and AGEs in elderly patients with CHF who did not respond to CRT treatment increased,which is related to the decline of cardiac function.Serum Cys-C,TBi L,MR-proADM and AGEs are the risk factors of non response to CRT treatment,which can provide a certain reference for the evaluation of CRT treatment effect.