血清MR-ProADM、Gal-3在慢性心力衰竭患者中的表达及临床意义

Expression and clinical significance of serum MR-ProADM and Gal-3 in patients with chronic heart failure

目的 观察血清肾上腺髓质前体中段肽(MR-ProADM)、半乳糖凝集素-3(Gal-3)在慢性心力衰竭(CHF)患者中的表达,并分析其临床意义。方法 前瞻性选取2020年7月至2021年6月在皖北煤电集团总医院治疗的80例CHF患者作为CHF组,再选取同期健康体检的健康人群80名作为对照组。将其按纽约心脏协会(NYHA)分级再次分组为NYHAⅡ级组(n=27)、NYHAⅢ级组(n=32)、NYHAⅣ级组(n=21)。将CHF组患者随访12个月,按是否发生终点事件再次分组为不良预后组(n=26)和非不良预后组(n=54)。比较CHF组与对照组、各NYHA分组,规范抗心力衰竭治疗前后各NYHA分组、不良预后组和非不良预后组患者入组时的血清MR-ProADM、Gal-3水平,并采用受试者工作特征(ROC)曲线分析血清MR-ProADM、Gal-3水平对CHF患者不良预后的预测价值。结果 CHF组患者血清MR-ProADM、Gal-3水平分别为(702.69±47.16) pmol/mL、(26.11±5.78) ng/mL,均明显高于对照组[(587.21±40.69) pmol/mL、(2.34±0.69) ng/mL],差异均有统计学意义(P<0.05)。CHF组患者中,NYHAⅣ级组患者的血清MR-ProADM、Gal-3水平分别为(755.93±62.37) pmol/mL、(36.85±7.95) ng/mL,均明显高于Ⅲ级组[(690.61±49.26) pmol/mL、(20.21±4.07) ng/mL]和Ⅱ级组[(625.87±48.56) pmol/mL、(13.69±3.28) ng/mL],差异均有统计学意义(P<0.05)。CHF组各NYHA分组经治疗后的血清MR-ProADM、Gal-3水平均明显低于同组治疗前,差异均有统计学意义(P<0.05)。不良预后组患者入组时血清MR-ProADM、Gal-3水平分别为(711.26±47.22) pmol/mL、(29.87±5.39) ng/mL,均明显高于非不良预后组[(639.58±45.73) pmol/mL、(15.61±3.78) ng/mL],差异均有统计学意义(P<0.05)。血清MR-ProADM、Gal-3检测联合对CHF患者不良预后评估的曲线下面积(AUC)为0.893(95%CI:0.772~0.951,P<0.001),高于单独检测血清MR-ProADM预测[AUC为0.751(95%CI:0.619~0.892,P<0.001)]或血清Gal-3预测的AUC[0.855(95%CI:0.751~0.935,P<0.001)]。结论 血清MR-ProADM、Gal-3可作为CHF诊断、危险分层、治疗效果评估、预后预测的生物标志物。

Objective To observe the expression of serum mid regional peptide of precursor adrenal medullary(MR-ProADM) and galactin-3(Gal-3) in patients with chronic heart failure(CHF) and analyze their clinical significance.Methods Eighty patients with CHF treated in the North Anhui Coal Power Group General Hospital from July 2020 to June 2021 were prospectatively selected as CHF group,then 80 healthy people who underwent physical examination during the same period were selected as the control group.And grouped again into NYHA Class Ⅱ group(n=27),NYHA Class Ⅲ group(n=32) and NYHA Class Ⅳ group(n=21) according to NYHA classification.Patients in the CHF group were followed up for 12 months and again divided into poor prognosis group(n=26) and non-poor prognosis group(n=54) according to the occurrence of endpoint events.Serum MR-ProADM and Gal-3 levels were compared between CHF group and control group,NYHA groups,poor prognosis group and non-poor prognosis group before and after standardized anti-heart failure treatment.The predictive value of serum MR-ProADM and Gal-3 levels on adverse prognosis of CHF patients was analyzed by receiver operating characteristic(ROC) curve.Results The levels of serum MR-ProADM and Gal-3 in the CHF group were(702.69±47.16) pmol/mL and(26.11±5.78) ng/mL,respectively,which were significantly higher than those in the control group [(587.21±40.69) pmol/mL and(2.34±0.69) ng/mL],the differences were statistically significant(P<0.05).In the CHF group,the serum MR-ProADM and Gal-3 levels in grade Ⅳ group were(755.93±62.37) pmol/mL,(36.85±7.95) ng/mL,respectively,which were significantly higher than those in grade Ⅲ group[(690.61±49.26) pmol/mL,(20.21±4.07) ng/mL] and grade Ⅱ group[(625.87±48.56) pmol/mL,(13.69±3.28) ng/mL],the differences were statistically significant(P<0.05).Serum MR-ProADM and Gal-3 levels of NYHA groups in CHF group after treatment were significantly lower than those before treatment,and the differences were statistically significant(P<0.05).The serum levels of MR-ProADM and Gal-3 in the poor prognosis group were(711.26±47.22) pmol/mL,(29.87±5.39) ng/mL,respectively,which were significantly higher than those in the non-poor prognosis group[(639.58±45.73) pmol/mL,(15.61±3.78) ng/mL],the differences were statistically significant(P<0.05).The area under the curve(AUC) of the combined detection of serum MR-ProADM and Gal-3 in the assessment of adverse outcomes in CHF patients was 0.893(95%CI:0.772-0.951,P<0.001),which was higher than that predicted by serum MR-ProADM alone [0.751(95%CI:0.619-0.892,P<0.001)],or serum Gal-3 predicted AUC[0.855(95%CI:0.751-0.935,P<0.001)].Conclusion Serum MR-ProADM and Gal-3 can be used as biomarkers for diagnosis,risk stratification,treatment effect evaluation and prognosis prediction of CHF.