血清UA、CysC、galectin-3与HFrEF患者1年内再入院的关系研究

Relationship between serum UA,CysC and galectin-3 with readmission within 1 year in HFrEF patients

目的探讨血清尿酸(UA)、胱抑素C(CysC)及半乳糖凝集素3(galectin-3)与左心室射血分数降低的心力衰竭(HFrEF)患者1年内再入院的关系。方法纳入研究对象共180例,均为该院2018年11月至2021年2月收治的HFrEF患者。以HFrEF患者出院后1年内再因心力衰竭入院为该研究终点,将所有患者分为再入院组(79例)与未再入院组(101例)。对比两组血清UA、CysC及galectin-3水平,以多因素Logistic回归分析HFrEF患者1年内再入院的危险因素。采用受试者工作特征(ROC)曲线探讨血清UA、CysC及galectin-3预测HFrEF患者1年内再入院的效能。结果再入院组血清UA、CysC及galectin-3水平分别为(492.75±31.82)μmol/L、(1.84±0.20)mg/L、(44.35±9.87)ng/mL,相较于未再入院组的(423.47±26.58)μmol/L、(1.12±0.17)mg/L、(32.19±5.42)ng/mL更高(P<0.05)。再入院组高血压、心包积液以及美国纽约心脏病协会(NYHA)心功能分级Ⅳ级人数占比相较于未再入院组更高(P<0.05);再入院组左心室射血分数(LVEF)低于未再入院组(P<0.05),且N末端脑钠肽前体(NT-proBNP)水平高于未再入院组(P<0.05)。多因素Logistic回归分析发现:高血压、心包积液、NYHA心功能分级Ⅲ/Ⅳ级以及血清UA、CysC、galectin-3、NT-proBNP水平升高均是HFrEF患者1年内再入院的危险因素(P<0.05),而LVEF水平升高为HFrEF患者1年内再入院的保护因素(P<0.05)。ROC曲线分析发现:血清UA、CysC及galectin-3联合预测HFrEF患者1年内再入院的效能(曲线下面积为0.866)优于上述3项指标单独预测。结论血清UA、CysC及galectin-3水平升高均是HFrEF患者出院后1年内再入院的危险因素,且血清UA、CysC及galectin-3联合检测能够辅助预测HFrEF患者出院后1年内再入院风险。

Objective To study the relationship between serum uric acid(UA),cystatin C(CysC)and galectin-3(galectin-3)with readmission within 1 year in heart failure patients with reduced left ventricular ejection fraction(HFrEF).Methods A total of 180 patients with HFrEF admitted and treated in this hospital from November 2018 to February 2021 were included in the study.The readmission to hospital due to heart failure within 1 year after discharge in the patients with HFrEF served as the end point of the study.All patients were divided into the readmission group(79 cases)and non-readmission group(101 cases).The levels of serum UA,CysC and galectin-3 were compared between the two groups and the risk factors of readmission within 1 year in the patients with HFrEF were analyzed by the multivariate Logistic regression.The receiver operating characteristic(ROC)curve was used to explore the efficiency of serum UA,CysC and galectin-3 in predicting the risk of readmission within 1 year in the patients with HFrEF.Results The levels of serum UA,CysC and galectin-3 in the readmission group were(492.75±31.82)μmol/L,(1.84±0.20)mg/L and(44.35±9.87)ng/mL respectively,which were higher compared with(423.47±26.58)μmol/L,(1.12±0.17)mg/L and(32.19±5.42)ng/mL in the non-readmission group(P<0.05).The proportions of the patients with hypertension,pericardial effusion and New York Heart Association(NYHA)cardiac function gradeⅣin the readmission group were higher than those in the non-readmission group(P<0.05).The level of left ventricular ejection fraction(LVEF)in the readmission group was lower than that in the non-readmission group,moreover the level of N-terminal pronatriuretic peptide(NT-proBNP)was higher than that in the non-readmission group(P<0.05).The multivariate Logistic regression analysis showed that hypertension,pericardial effusion,NYHA cardiac function gradeⅢ/Ⅳand elevated levels of serum UA,CysC,galectin-3 and NT-proBNP were the risk factors for readmission within 1 year in the patients with HFrEF(P<0.05),while elevated LVEF was a protective factor for readmission within 1 year in the patients with HfrEF(P<0.05).The ROC curve analysis showed that the combination of serum UA,CysC and galectin-3 levels in predicting(the area under the curve was 0.866)the readmission within 1 year in the patients with HFrEF was better than the above three indicators alone.Conclusion The increase of serum UA,CysC and galectin-3 levels are all the risk factors for readmission within 1 year after discharge in the patients with HFrEF,moreover the combined detection of serum UA,CysC and galectin-3 could help predict the risk of readmission within 1 year after discharge in the patients with HFrEF.