血清白细胞介素-8、血管紧张素Ⅱ与慢性心力衰竭患者临床预后的关系

Relationship between serum interleukin-8,angiotensin-2 with clinical prognosis in patients with chronic heart failure

目的探讨血清白细胞介素(IL)-8、血管紧张素Ⅱ(AngⅡ)水平与慢性心力衰竭(CHF)患者临床预后的关系。方法选取CHF患者168例,根据随访1年内预后情况分为病死组(28例)和存活组(140例)。收集所有患者基线资料及实验室检查指标并分组进行比较,采用cox回归分析评估相关因素对CHF患者临床预后的影响;采用受试者工作特征(ROC)曲线评估治疗前IL-8、AngⅡ水平对CHF患者临床预后的预测价值;采用限制性立方样条函数评估IL-8、AngⅡ水平与CHF患者临床预后的OR值关系,采用样条函数与回归分析相结合的限制性立方样条法分析IL-8、AngⅡ水平与CHF患者临床预后的剂量反应关系。结果两组患者美国纽约心脏病协会(NYHA)分级构成比比较差异有统计学意义;病死组患者治疗前同型半胱氨酸(Hcy)、心肌肌钙蛋白I(cTnI)、脑钠肽(BNP)、IL-8、AngⅡ水平均高于存活组(P<0.05)。Cox回归分析结果显示,治疗前Hcy、cTnI、BNP、IL-8、AngⅡ水平高是CHF患者临床预后不良的危险因素(P<0.05)。ROC曲线分析结果显示,IL-8、AngⅡ对CHF患者临床预后的预测有一定价值,其中二者联合的预测价值最高(P<0.001)。IL-8≤117.965μg/L患者1年存活率高于IL-8>117.965μg/L患者,AngⅡ≤26.395 pg/ml患者1年存活率高于AngⅡ>26.395 pg/ml患者(P<0.05)。限制性立方样条法分析结果显示,IL-8、AngⅡ水平与CHF患者临床预后的关联强度呈线性剂量反应关系,与CHF患者临床预后呈正相关;当IL-8>117.965μg/L、AngⅡ>26.395 pg/ml时,CHF患者1年内病死风险随IL-8、AngⅡ的升高而升高(P<0.05)。结论治疗前血清IL-8、AngⅡ水平高是CHF患者临床预后不良的危险因素,且不同IL-8、AngⅡ水平CHF患者临床预后存在差异。

Objective To investigate the relationship between interleukin(IL)-8 and angiotensin 2(AngⅡ)levels with clinical prognosis in chronic heart failure(CHF)patients.Methods 168 patients with CHF were selected and divided into death group(28 cases)and survival group(140 cases)according to the prognosis within 1 year of follow-up.The baseline data and laboratory examination indexes of all patients were collected and compared in groups.Cox regression analysis was used to evaluate the influence of related factors on the clinical prognosis of CHF patients.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of IL-8 and AngⅡlevels in the clinical prognosis of CHF patients before treatment.Restricted cubic spline function was used to evaluate the relationship between IL-8 and AngⅡlevels with clinical prognosis of CHF patients,and the OR value.The dose-response relationship between IL-8 and AngⅡlevels with clinical prognosis of CHF patients was analyzed by restricted cubic spline function combined with regression analysis.Results There were statistical significant differences in the composition ratio of cardiac function New York Heart Association(NYHA)classification between the two groups;The levels of homocysteine(Hcy),cardiac troponin I(cTnI),brain natriuretic peptide(BNP),IL-8 and AngⅡin death group before treatment were higher than those in survival group(P<0.05).Cox regression analysis showed that high levels of Hcy,cTnI,BNP,IL-8 and AngⅡbefore treatment were risk factors for poor clinical prognosis of CHF patients(P<0.05).ROC curve analysis showed that IL-8 and AngⅡhad certain value in predicting the clinical prognosis of CHF patients,and the combination of the two had the highest predictive value(P<0.001).1 year survival rate of patients with IL-8≤117.965μg/L was higher than that in patients with IL-8>117.965μg/L,1 year survival rate of patients with AngⅡ≤26.395 pg/ml was higher than in patients with AngⅡ>26.395 pg/ml(P<0.05).Restricted cubic spline analysis showed that correlation between IL-8 and AngⅡlevels with clinical prognosis of CHF patients was linear dose-response relationship,while positively correlated with the clinical prognosis of CHF patients;When IL-8>117.965μg/L and AngⅡ>26.395 pg/ml,the risk of death in CHF patients within 1 year increased with the increase of IL-8 and AngⅡ(P<0.05).There were statistical significant differences in the proportion of patients with different levels of IL-8 and AngⅡbetween the two groups(P<0.05).Conclusion The high levels of serum IL-8 and AngⅡbefore treatment are risk factors for poor prognosis in CHF patients,and the clinical prognosis is different in patients with different levels of IL-8 and AngⅡ.