慢性心力衰竭患者血清hs⁃CRP、sST2水平与心脏再同步化治疗后室性心律失常的相关性

The correlation between serum hs⁃CRP,sST2 levels and ventricular arrhythmia after cardiac resynchronization ther⁃apy in patients with chronic heart failure

目的探究血清高敏C反应蛋白(hs⁃CRP)、可溶性致癌抑制因子2(sST2)水平与慢性心力衰竭患者经心脏再同步化治疗(CRT)后发生室性心律失常(VA)的关系。方法收集2018年1月—2021年7月陆军军医大学第二附属医院心内科收治并行CRT的慢性心力衰竭患者179例为研究对象,根据CRT后1年是否发生室性心律失常将患者分为未发生VA组141例和发生VA组38例。收集2组患者临床资料,记录患者CRT后1年室性心律失常指标[校正的QT间期(QTc)、校正后Tp⁃Te间期(Tp⁃Tec)],采用双抗体夹心—酶联免疫吸附法检测血清hs⁃CRP、sST2水平;采用Spearman法分析血清hs⁃CRP、sST2与纽约心脏病协会(NYHA)心功能分级、室性心律失常的相关性,Pear⁃son法分析血清hs⁃CRP与sST2以及二者分别与左心室射血分数(LVEF)、血红蛋白(Hb)、心肌肌钙蛋白I(cTnI)、QTc、Tp⁃Tec的相关性;采用受试者工作特征曲线(ROC)评价血清hs⁃CRP、sST2水平对慢性心力衰竭患者CRT后发生室性心律失常的预测价值;采用多因素Logistic回归分析影响慢性心力衰竭患者CRT后发生室性心律失常的危险因素。结果发生VA组NYHA心功能分级≥Ⅱ级人数所占比例及cTnI、QTc、Tp⁃Tec、hs⁃CRP、sST2水平高于未发生VA组(χ^(2)/t=12.604、11.417、9.135、9.513、12.967、23.484,P均<0.001),LVEF、Hb水平低于未发生VA组(t/P=4.312/<0.001、2.531/0.012)。慢性心力衰竭患者血清hs⁃CRP与sST2水平呈正相关(r/P=0.716/<0.001),血清hs⁃CRP、sST2水平与NYHA心功能分级、cTnI、QTc、Tp⁃Tec、室性心律失常呈正相关(hs⁃CRP:r=0.629、0.558、0.672、0.704、0.764,P均<0.001;sST2:r=0.657、0.542、0.618、0.693、0.782,P均<0.001),与LVEF、Hb水平呈负相关(hs⁃CRP:r=-0.583、-0.605,P均<0.001;sST2:r=-0.551、-0.629,P均<0.001)。血清hs⁃CRP、sST2及两者联合预测慢性心力衰竭患者CRT后发生室性心律失常的曲线下面积(AUC)分别为0.862、0.887、0.964,两者联合预测的AUC高于单项预测(Z/P=2.882/0.004、2.250/0.025);NYHA心功能分级≥Ⅱ级、cTnI高、QTc高、Tp⁃Tec高、hs⁃CRP高、sST2高是影响慢性心力衰竭患者CRT后发生室性心律失常的独立危险因素[OR(95%CI)=1.772(1.158~2.711)、2.066(1.243~3.431)、1.488(1.120~1.977)、1.596(1.095~2.325)、2.307(1.343~3.963)、1.819(1.210~2.735)],LVEF高为其独立保护因素[OR(95%CI)=0.853(0.738~0.986)]。结论慢性心力衰竭CRT后发生室性心律失常患者血清hs⁃CRP、sST2水平呈高表达,两者联合对室性心律失常的发生有一定预测价值,两者升高是发生室性心律失常的危险因素。

Objective To explore the relationship between the levels of serum high⁃sensitivity C⁃reactive protein(hs⁃CRP)and soluble carcinogenic inhibitor 2(sST2)and the occurrence of ventricular arrhythmia in patients with chronic heart failure after cardiac resynchronization therapy(CRT).Methods One hundred and seventy⁃nine patients with chronic heart failure admitted to the Department of Cardiology of the Second Affiliated Hospital of the Military Medical University of the Army from January 2018 to July 2021 were selected as the study subjects.According to whether ventricular arrhythmia occurred one year after CRT,the patients were divided into 141 patients in the non⁃occurrence group and 38 patients in the occurrence group.The clinical data of two groups of patients were collected,and the indexes of ventricular arrhythmias[corrected QT interval(QTc)and corrected Tp⁃Te interval(TP⁃Tec)]were recorded one year after CRT;Spearman method was used to analyze the correlation between serum hs⁃CRP,sST2 and NYHA cardiac function classification and ventricular ar⁃rhythmia.Pearson method was used to analyze the correlation between serum hs⁃CRP,sST2 and left ventricular ejection frac⁃tion(LVEF),hemoglobin(Hb),cardiac troponin I(cTnI),QTc,TP⁃Tec,respectively;To evaluate the predictive value of ser⁃um hs⁃CRP and sST2 levels on the occurrence of ventricular arrhythmias in patients with chronic heart failure after CRT by using the subject working characteristic curve(ROC);Multivariate logistic regression was used to analyze the risk factors of ventricular arrhythmia in patients with chronic heart failure after CRT.Results The proportion of people with NYHA cardi⁃ac function grade≥grade II and the levels of cTnI,QTc,TP⁃Tec,hs⁃CRP and sST2 in the occurrence group were higher than those in the non⁃occurrence group(χ^(2)/t=12.604,11.417,9.135,9.513,12.967,23.484,P<0.001),LVEF and Hb levels were lower than those in the non⁃occurrence group(t/P=4.312/<0.001,2.531/0.012).In patients with chronic heart failure,serum hs⁃CRP and sST2 levels were positively correlated(r/P=0.716/<0.001),and serum hs⁃CRP and sST2 levels were positively correlated with NYHA cardiac function grading,cTnⅠ,QTc,TP⁃Tec,and ventricular arrhythmia(hs⁃CRP:r=0.629,0.558,0.672,0.704,0.764,P<0.001;sST2:r=0.657,0.542,0.618,0.693,0.782,P<0.001),and LVEF The Hb level was negatively correlated(hs⁃CRP:r=-0.583,-0.605,P<0.001;sST2:r=-0.551,-0.629,P<0.001).The area under the curve(AUC)of serum hs⁃CRP,sST2 and their combination in predicting ventricular arrhythmia after CRT in patients with chronic heart failure were 0.862,0.887 and 0.964,respectively.The AUC predicted by the combination of the two was higher than that predicted by the single prediction(Z/P=2.882/0.004,2.250/0.025).NYHA cardiac function grade≥grade II,high cTnI,high QTc,high TP⁃Tec,high hs⁃CRP,and high sST2 are independent risk factors for the occurrence of ventricular arrhythmia after CRT in patients with chronic heart failure[OR(95%CI)=1.772(1.158-2.711),2.066(1.243-3.431),1.488(1.120-1.977),1.596(1.095-2.325),2.307(1.343-3.963),1.819(1.210-2.735)],High LVEF is an independent protective factor[OR(95%CI)=0.853(0.738-0.986)].Conclusion The serum levels of hs⁃CRP and sST2 were highly expressed in patients with ventricular arrhythmia after CRT in chronic heart failure.The combination of the two had certain predictive value for the occurrence of ventricular arrhythmia,and the increase of both was a risk factor for the occurrence of ventricular arrhythmia.