CHF患者CRP/Alb、PDGF、BUN/Cr水平变化及对预后的评估价值

Changes in CRP/Alb,PDGF and BUN/Cr levels in chronic heart failure patients and their prognostic value

目的 探讨慢性心力衰竭(CHF)患者C-反应蛋白与白蛋白比值(CRP/Alb)、血小板源性生长因子(PDGF)联合血尿素氮与肌酐比值(BUN/Cr)水平变化,并分析各指标预测心血管死亡和全因死亡的效能。方法 选取2020年1月至2022年3月收治的109例CHF患者,根据1年内心血管死亡和全因死亡情况分为死亡组(26例)和存活组(83例)。比较2组社会人口学资料和临床特征[美国纽约心脏病学会心功能分级(NYHA)、左心室射血分数、左心室舒张末期内径、左心室收缩末期内径、N-末端脑钠肽前体(NT-proBNP)、临床用药]、CRP/Alb、PDGF、BUN/Cr水平,分析CRP/Alb、PDGF、BUN/Cr水平的相关性,采用Cox回归分析CHF患者心血管死亡和全因死亡的相关影响因素,采用受试者工作特征曲线(ROC)分析预测价值,采用卡普兰-迈耶曲线(K-M)生存曲线分析不同CRP/Alb、PDGF、BUN/Cr水平患者的生存率。结果 死亡组NYHA心功能分级、左心室舒张末期内径、左心室收缩末期内径、NT-proBNP高于存活组,左心室射血分数低于存活组(P<0.05);死亡组CRP/Alb、PDGF、BUN/Cr高于存活组(P<0.05);CHF患者CRP/Alb与PDGF、BUN/Cr呈正相关,PDGF与BUN/Cr呈正相关(P<0.05);在校正了NYHA心功能分级等混杂因素后,CRP/Alb、PDGF、BUN/Cr仍是CHF患者心血管死亡和全因死亡的相关影响因素(P<0.05);CRP/Alb、PDGF、BUN/Cr预测心血管死亡和全因死亡的ROC下面积(AUC)分别为0.712、0.801、0.738,三者联合时的AUC为0.911(P<0.05);CRP/Alb、PDGF、BUN/Cr高水平患者生存率低于低水平患者(P<0.05)。结论 CRP/Alb、PDGF、BUN/Cr与CHF患者心血管死亡和全因死亡有关,联合检测可作为预测患者病情转归的一个方案,为临床评估预后、治疗等提供参考依据。

Objective To investigate the changes in the levels of C-reactive protein to albumin ratio(CRP/Alb),platelet-derived growth factor(PDGF) and blood urea nitrogen to creatinine ratio(BUN/Cr) in patients with chronic heart failure(CHF),and to analyze their efficacy in predicting cardiovascular mortality and all-cause mortality.Methods A total of 109 CHF patients admitted to our hospital from January 2020 to March 2022 were selected.They were divided into death group(26 cases) and survival group(83 cases) according to cardiovascular death and all-cause mortality within 1 year.The sociodemographic data,clinical characteristics(New York Heart Association [NYHA] cardiac function classification,left ventricular ejection fraction[LVEF],left ventricular end-systolic diameter [LVESD],left ventricular end-diastolic diameter [LVEDD],N-terminal brain natriuretic peptide precursor [NT-proBNP],clinical medication),CRP/Alb,PDGF,and BUN/Cr levels were compared between the two groups.Cox regression was used to analyze influencing factors for the cardiovascular mortality and all-cause mortality.The receiver operating characteristic(ROC) curve was plotted to analyze the predictive value,and the Kaplan-Meier curve(K-M) survival curve was plotted to analyze the survival rate of CHF patients with different CRP/Alb,PDGF,and BUN/Cr levels.Results NYHA cardiac function classification,LVESD,LVEDD and NT-proBNP were significantly higher in the death group than those of the survival group,and LVEF was significantly lower(P<0.05).CRP/Alb,PDGF,and BUN/Cr were significantly higher in the death group than those of the survival group(P<0.05).CRP/Alb in CHF patients was positively correlated with PDGF and BUN/Cr,and PDGF was positively correlated with BUN/Cr(P<0.05).After adjustment for confounding factors(e.g.,NYHA cardiac function class),CRP/Alb,PDGF,and BUN/Cr were still influencing factors for cardiovascular death and all-cause mortality in CHF patients(P<0.05).The area under the curve(AUC) CRP/Alb,PDGF,BUN/Cr and their combination in predicting cardiovascular death and all-cause death was 0.712,0.801,0.738,and 0.911,respectively(P<0.05).CHF patients with high levels of CRP/Alb,PDGF,and BUN/Cr had a significantly lower survival than those with low levels(P<0.05).Conclusion CRP/Alb,PDGF,and BUN/Cr are correlated with cardiovascular mortality and all-cause mortality in CHF patients,and their combination detection can be used to predict the outcome of CHF,thus providing references for assessing the prognosis and treatment.