血清MSTN水平联合NRS2002评分对老年慢性心力衰竭近期预后的评估价值

The value of serum MSTN levels combined with the NRS2002 score in assessing the near-term prognosis of chronic heart failure in the elderly

目的 探讨血清肌肉生长抑制素(MSTN)水平联合营养风险筛查2002 (NRS2002)评分对老年慢性心力衰竭(CHF)近期预后的评估价值。方法 选取2020年1月~2022年3月我院收治的123例老年CHF患者(CHF组),根据住院期间是否死亡分为预后不良组28例和预后良好组95例,另选取同期48例体检健康的老年志愿者作为对照组。采用酶联免疫吸附法检测血清MSTN水平,并计算NRS2002评分。采用多因素Logistic回归分析老年CHF患者近期预后不良的影响因素,ROC曲线分析血清MSTN水平和NRS2002评分对老年CHF患者近期预后的评估价值。结果 CHF组血清MSTN水平和NRS2002评分高于对照组(P<0.05)。预后不良组血清MSTN水平和NRS2002评分高于预后良好组(P<0.05)。多因素Logistic回归分析显示,NYHA心功能分级≥Ⅲ级、N末端脑钠肽前体升高、MSTN升高、NRS2002评分增加为老年CHF患者近期预后不良的独立危险因素,左室射血分数升高为独立保护因素(OR=4.031,95%CI:1.710~9.502、OR=1.003,95%CI:1.001~1.005、OR=1.086,95%CI:1.033~1.141、OR=2.810,95%CI:1.361~3.174、OR=0.755,95%CI:0.620~0.921)。ROC曲线分析显示,血清MSTN水平和NRS2002评分单独与联合评估老年CHF患者近期预后的曲线下面积分别为0.786、0.798、0.881,灵敏度分别为89.29%、85.71%、89.29%,特异度分别为55.79%、65.26%、74.74%。结论 血清MSTN水平升高和NRS2002评分增加为老年CHF患者近期预后不良的独立危险因素,二者联合对老年CHF患者近期预后的评估价值较高。

Objective To investigate the value of serum muscle growth inhibitor(MSTN)levels combined with nutritional risk screening 2002(NRS2002)scores in assessing the near-term prognosis of chronic heart failure(CHF)in the elderly.Methods One hundred and twenty-three elderly patients with CHF admitted to our hospital from January 2020 to March 2022(CHF group)were selected and divided into 28 cases in the poor prognosis group and 95 cases in the good prognosis group according to whether they died during hospitalization,and another 48 elderly volunteers with healthy physical examination(control group)were selected during the same period.Serum MSTN levels were measured by enzyme-linked immunosorbent assay and the NRS2002 score was calculated.Multi-factor logistic regression was used to analyze the factors influencing the poor near-term prognosis of elderly CHF patients,and ROC curves were used to analyze the value of serum MSTN levels and NRS2002 score in assessing the near-term prognosis of elderly CHF patients.Results Serum MSTN levels and NRS2002 scores were higher in the CHF group than in the control group(P<0.05).Serum MSTN levels and NRS2002 scores were higher in the poor prognosis group than in the good prognosis group(P<0.05).Multifactorial logistic regression analysis showed that NYHA cardiac function class≥Ⅲ,elevated N-terminal B-type natriuretic peptide precursors,elevated MSTN,and increased NRS2002 score were independent risk factors for poor near-term prognosis in elderly CHF patients,and elevated left ventricular ejection fraction was an independent protective factor[OR(95%CI)=4.031(1.710~9.502),1.003(1.001~1.005),1.086(1.033~1.141),2.810(1.361~3.174),0.755(0.620~0.921)].ROC curve analysis showed that the area under the curve for serum MSTN levels and NRS2002 scores alone and in combination to assess the near-term prognosis of elderly CHF patients were 0.786,0.798,and 0.881,respectively with sensitivities of 89.29%,85.71%,and 89.29%and specificities of 55.79%,65.26%,and 74.74%,respectively.Conclusion Elevated serum MSTN levels and increased NRS2002 scores are independent risk factors for poor near-term prognosis in elderly CHF patients,and the combination of the two is of high value in assessing the nearterm prognosis of elderly CHF patients.