慢性心力衰竭患者血清脂肪细胞因子水平与其心血管终点事件的关系

Correlations between serum adipocytokines and cardiovascular end points in patients with chronic heart failure

目的探讨慢性心力衰竭(CHF)患者血清脂肪细胞因子水平与其主要心血管终点事件(MACE)的关系。方法选择2018年4月至2020年8月收治的CHF患者136例,根据患者出院1年后有无MACE分成MACE组(n=62)、无MACE组(n=74),取同期无心血管疾病的体检者65例为对照组。比较3组血清脂肪素(apelin)、内脏脂肪组织源性丝氨酸蛋白酶抑制剂(vaspin)、脂肪因子趋化素(chemerin)、网膜素(omentin)水平及氨基末端脑钠肽前体(NT-proBNP)、心功能指标、炎症指标,分析CHF患者脂肪细胞因子与其他指标的相关性。采用多因素logistic回归模型分析CHF患者MACE发生的危险因素。结果MACE组、无MACE组的血清chemerin、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、NT-proBNP水平及左心房内径(LAD)、左室舒张末内径(LVEDD)、左室收缩末内径(LVESD)、左心室后壁厚度(LVPW)高于对照组,其中MACE组高于无MACE组。MACE组、无MACE组的血清apelin、vaspin、omentin水平及左室射血分数(LVEF)低于对照组,且MACE组低于无MACE组(P<0.05)。CHF患者血清apelin、vaspin、omentin与IL-6、TNF-α、CRP、NT-proBNP、LAD、LVEDD、LVESD、LVPW呈负相关,与LVEF呈正相关,而chemerin则与IL-6、TNF-α、CRP、NT-proBNP、LAD、LVEDD、LVESD、LVPW呈正相关,与LVEF呈负相关(P<0.05)。多因素logistic回归模型分析提示CRP、NT-proBNP、LAD、LVEDD、LVESD、chemerin增高是CHF患者MACE发生的危险因素,LVEF、apelin、vaspin、omentin增高是预防MACE发生的保护因素(P<0.05)。血清apelin、vaspin、chemerin、omentin预估CHF患者MACE发生的敏感度分别为87.10%、88.71%、82.26%、80.65%,特异度分别为87.84%、81.08%、85.14%、79.73%。结论CHF患者血清apelin、vaspin、omentin水平下降,chemerin水平增高,四者与患者的炎症因子、心功能指标具有相关性,对CHF患者MACE的发生有一定评估价值。

Objective To investigate the correlation between serum adipocytokines levels and major adverse cardiovascular event(MACE)in patients with chronic heart failure(CHF).Methods From April 2018 to August 2020,136 patients with CHF who were treated in our hospital were selected,and divided into MACE group(n=62)and non-MACE group(n=74)according to whether they had MACE one year after discharge.Sixty-five people without cardiovascular disease in the same period were taken as the control group.The levels of serum apelin(apelin),visceral adipose tissue derived serine protease inhibitor(vaspin),chemerin,omentin,N-terminal probrain natriuretic peptide(NT-proBNP),cardiac function indexes and inflammation indexes were compared among the three groups.The correlations between adipocytokines and other indexes in patients with CHF were analyzed.Multivariate logistic regression model was used to analyze the risk factors of occurrence of MACE in patients with CHF.Results Serum chemerin,interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),and NT-proBNP levels;left atrial diameter(LAD),left ventricular end diastolic dimension(LVEDD),left ventricular end-systolic dimension(LVESD)and left ventricular posterior wall thickness(LVPW)in the MACE group and non-MACE group were significantly higher than those in control group;which were significantly higher in MACE group was higher than the non-MACE group(P<0.05).Serum apelin,vaspin and omentin levels and left ventricular ejection fractions(LVEF)in MACE group and non-MACE group were significantly lower than those in control group,which were significantly lower in MACE group than the non-MACE group(P<0.05).Serum apelin,vaspin and omentin of patients with CHF were negatively correlated with IL-6,TNF-α,CRP,NT-proBNP,LAD,LVEDD,LVESD and LVPW;and positively correlated with LVEF.Chemerin was positively correlated with IL-6,TNF-α,CRP,NT-proBNP,LAD,LVEDD,LVESD and LVPW;and negatively correlated with LVEF(P<0.05).Multivariate logistic regression model analysis suggested that the increase of CRP,NT-proBNP,LAD,LVEDD,LVESD and chemerin were risk factors for MACE in patients with CHF.The increases of LVEF,apelin,vaspin and omentin were protective factors of MACE(P<0.05).The sensitivities of serum apelin,vaspin,chemerin and omentin to predict the occurrence of MACE in CHF patients were 87.10%,88.71%,82.26%and 80.65%,respectively;and the specificities were 87.84%,81.08%,85.14%and 79.73%,respectively.Conclusion The levels of apelin,vaspin and omentin decrease and the level of chemerin increases in patients with CHF,which are correlated with the inflammatory factors and cardiac function indexes of patients,and has certain evaluation value for the occurrence of MACE in patients with CHF.