单胺氧化酶和白细胞介素-6在慢性肾衰竭并发心力衰竭患者中的诊断及预后评估价值

Diagnostic and Prognostic Value of Monoamine Oxidase and Interleukin-6 in Patients with Chronic Renal Failure Complicated with Heart Failure

目的 探究单胺氧化酶(monoamine oxidase,MAO)和白细胞介素-6(interleukin-6,IL-6)在慢性肾衰竭(chronic renal failure,CRF)并发心力衰竭(heart failure,HF)患者中的诊断及预后评估价值。方法 回顾性分析邯郸明仁医院2018年2月至2019年2月收治的CRF患者121例,其中单纯CRF患者50例(单纯CRF组)、合并HF的患者71例(CRF-HF组),同期选取60名健康体检者作为对照组,比较3组受试者的血清MAO、IL-6浓度及心功能,并行相关性分析,同时绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)分析血清MAO、IL-6浓度对CRF并HF患者的诊断及预后评估。结果 单纯CRF组和CRF-HF组患者的血清MAO、IL-6浓度明显高于对照组,且CRF-HF组高于单纯CRF组,差异有统计学意义(P均<0.01)。单纯CRF组和CRF-HF组患者的左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)均明显大于对照组,左心室射血分数(left ventricular ejection fraction,LVEF)均明显小于对照组,且CRF-HF组又分别大于和小于单纯CRF组,差异有统计学意义(P均<0.01)。Pearson相关性分析显示,CRF-HF患者血清MAO、IL-6浓度均与LVEF呈明显负相关(P均<0.01),均与LVESD、LVEDD呈明显正相关(P均<0.01)。血清MAO的诊断灵敏度、特异度分别为85.92%、85.00%,ROC曲线下面积(area under the curve,AUC)为0.898(95%CI:0.844~0.953,P<0.01),预后AUC为0.902(95%CI:0.833~0.971,P<0.01)。血清IL-6诊断CRF并HF的灵敏度、特异度分别为92.96%、81.67%,AUC为0.939(95%CI:0.901~0.976,P<0.01),预后AUC为0.880(95%CI:0.795~0.964,P<0.01)。结论 血清MAO、IL-6在CRF并HF中均呈高表达,且与患者心功能具有明显相关性,二者在CRF并HF患者的诊断及预后评估中具有重要的价值,有望成为诊断和预测CRF并HF患者预后的新型标志物。

Objectives To explore the diagnostic and prognostic value of monoamine oxidase(MAO)and interleukin-6(IL-6)in patients with chronic renal failure(CRF)complicated with heart failure(HF).Methods A retrospective analysis of 121 patients with CRF admitted to Handan Mingren Hospital from February 2018 to February 2019 was carried out,including 50 patients with pure CRF(simple CRF group)and 71 patients with HF(CRF-HF group).During the same period,60 healthy subjects were selected as control group.Serum concentrations of MAO,IL-6 and cardiac function of subjects in the three groups were compared,and the correlation analysis was carried out.At the same time,receiver operating characteristic curve(ROC)was drawn to analyze serum concentrations of MAO and IL-6 in the diagnosis and prognosis evaluation of patients with CRF and HF.Results Serum concentrations of MAO and IL-6 in pure CRF group and CRF-HF group were significantly higher than those in control group,and those in CRF-HF group were higher than those in pure CRF group(all P<0.01).Left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)of pure CRF group and CRF-HF group were significantly greater than those of control group,and left ventricular ejection fraction(LVEF)was significantly less than that of control group,and those in CRF-HF group were greater and lower than those in pure CRF group respectively(all P<0.01).Pearson correlation analysis showed that serum concentrations of MAO and IL-6 in CRF-HF patients were significantly negatively correlated with LVEF(all P<0.01),and both were significantly positively correlated with LVESD and LVEDD(all P<0.01).The diagnostic sensitivity and specificity of serum concentration of MAO were 85.92%and 85.00%,respectively,the area under the ROC curve(AUC)was 0.898(95%CI:0.844-0.953,P<0.01),and the prognosis AUC was 0.902(95%CI:0.833-0.971,P<0.01).The sensitivity and specificity of serum concentration of IL-6 in diagnosing CRF with HF were 92.96%and 81.67%,AUC was 0.939(95%CI:0.901-0.976,P<0.01),and the prognosis AUC was 0.880(95%CI:0.795-0.964,P<0.01).Conclusions Serum MAO and IL-6 are highly expressed in patients with CRF and HF,and have significant correlations with patients′cardiac function.They have important promotion values in the diagnosis and prognostic evaluation of patients with CRF and HF,and are expected to be used in the diagnosis and prediction of CRF and novel markers of HF prognosis.