血清8-OHdG联合动态动脉僵硬指数对高血压伴慢性心力衰竭患者主要不良心血管事件的预测价值

The predictive value of serum 8-OHdG combined with dynamic arterial stiffness index for major adverse cardiovascular events in patients with hypertension and chronic heart failure

目的分析血清8-羟基脱氧鸟苷(8-OHdG)联合动态动脉僵硬指数(AASI)对高血压伴慢性心力衰竭患者主要不良心血管事件(MACE)的预测价值。方法选取2019年1月-2022年1月于皖南医学院第二附属医院心血管内科诊治高血压伴慢性心力衰竭患者132例,根据出院后1年内是否发生MACE分为MACE组(n=42)和非MACE组(NMACE组,n=90)。比较2组患者临床资料、血清8-OHdG和AASI的差异;多因素Logistic回归分析高血压伴慢性心力衰竭患者发生MACE的危险因素;受试者工作特征曲线(ROC)分析血清8-OHdG、AASI对高血压伴慢性心力衰竭患者并发MACE的诊断价值。结果随访1年,高血压伴慢性心力衰竭患者MACE的发生率为31.82%(42/132)。MACE组患者8-OHdG、AASI、NYHA心功能分级级别、肿瘤坏死因子-α(TNF-α)、臂踝动脉脉搏传导速度(ba-PWV)均显著高于NMACE组[t(χ^(2))/P=16.881/<0.001、12.437/<0.001、8.921/0.030、7.234/<0.001、9.492/<0.001],而左心室射血分数(LVEF)明显低于NMACE组(t/P=6.095/<0.001);Logistic多因素回归分析显示,血清8-OHdG高、AASI高均是高血压伴慢性心力衰竭患者发生MACE的危险因素[OR(95%CI)=2.447(1.809~3.309)、1.853(1.471~2.336)];ROC曲线分析显示,血清8-OHdG、AASI及二者联合预测高血压伴慢性心力衰竭患者并发MACE的ROC曲线下面积(AUC)分别为0.756、0.712、0.867,二者联合预测AUC高于单项指标(Z/P=2.969/0.031、3.558/0.015)。结论高血压伴慢性心力衰竭并发MACE的患者血清8-OHdG、AASI明显升高,是高血压伴慢性心力衰竭并发MACE的独立危险因素,二者联合检测可提高对患者并发MACE的诊断效能。

Objective To analyze the predictive value of serum 8-hydroxy Deoxyguanosine(8-OHdG)combined with dynamic arterial stiffness index(AASI)for major adverse cardiovascular events(MACE)in patients with hypertension and chronic heart failure.Methods One hundred and thirty-two patients with hypertension and chronic heart failure who were diagnosed and treated in Cardiovascular Department of the Second Affiliated Hospital of Wannan Medical College from January 2019 to January 2022 were selected.According to whether MACE occurred within one year after discharge,they were divided into MACE group and non-MACE group(NMACE group).Compare the differences in clinical data,serum 8-OHdG,and AASI between two groups of patients;Multivariate logistic regression analysis of risk factors for MACE in patients with hypertension and chronic heart failure;The diagnostic value of receiver operating characteristic curve(ROC)analysis of serum 8-OHdG and AASI in patients with hypertension and chronic heart failure complicated with MACE.Results Following up for one year,the incidence of MACE in patients with hypertension and chronic heart failure was 31.82%(42/132).MACE group patients’8-OHdG,AASI,NYHA cardiac function grading,tumor necrosis factor-α(TNF-α),the brachial ankle artery pulse conduction velocity(ba PWV)were significantly higher than that of the NMACE group,while the left ventricular Ejection fraction(LVEF)was significantly lower than that of the NMACE group[t(χ^(2))/P=16.881/<0.001,12.437/<0.001,8.921/0.030,7.234/<0.001,9.492/<0.001,6.095/<0.001];Logistic multivariate regression analysis showed that high serum 8-OHdG and AASI were both risk factors for MACE in patients with hypertension and chronic heart failure[OR(95%CI)=2.447(1.809-3.309),1.853(1.471-2336)];The analysis of Receiver operating characteristic showed that the area under the Receiver operating characteristic(AUC)predicted by serum 8-OHdG,AASI and their combination for hypertension patients with chronic heart failure complicated with MACE were 0.756,0.712 and 0.867,respectively.The AUC predicted by both was higher than the single index(Z/P=2.969/0.031,3.558/0.015).Conclusion Patients with hypertension and chronic heart failure complicated by MACE have significantly elevated serum 8-OHdG and AASI,which are independent risk factors for hypertension and chronic heart failure complicated by MACE.Combined detection of the two can improve the diagnostic efficacy of patients with MACE.