淋巴细胞亚群与慢性心力衰竭射血分数保留老年患者心功能分级的相关性

Correlation of lymphocyte subpopulation changes with cardiac function grading in elderly patients with ejection fraction retention and its impact on the prognosis of chronic heart failure

目的:分析慢性心力衰竭射血分数保留老年患者机体中淋巴细胞亚群变化与心功能分级的关系。方法:回顾性选取2022年8月至2023年6月我院治疗的射血分数保留老年患者835例,按照心功能分级分为Ⅰ级302例,Ⅱ级254例,Ⅲ级144例和Ⅳ级135例,选取同期射血分数未保留的老年患者211例作为对照组。收集患者一般资料,对比分析T淋巴细胞亚群、血清心脏相关因子水平在不同心功能分级患者中的表达。结果:两组患者的年龄、性别、体质指数(BMI)、收缩压、舒张压以及心率等一般资料差异无统计学意义(P>0.05)。心功能分级越低的患者机体T淋巴细胞亚群中的CD4+[Ⅰ级:(39.7±8.0)%,Ⅱ级:(36.9±8.3)%,Ⅲ级:(32.1±6.5)%,Ⅳ级:(31.3±5.1)%]、CD4+/CD8+[Ⅰ级:(1.8±0.5),Ⅱ级:(1.5±0.5),Ⅲ级:(1.4±0.5),Ⅳ级:(1.1±0.3)]水平越高,CD8+[Ⅰ级:(23.9±5.1)%,Ⅱ级:(25.5±8.4)%,Ⅲ级:(26.3±10.0)%,Ⅳ级:(30.7±9.0)%]水平降低(F=56.846、84.154、23.965,均P<0.05);心功能分级越低的患者机体血清中的生长刺激表达基因2蛋白(sST2)、半乳糖凝集素-3(GAL-3)以及生长分化因子15(GDF-15)水平越低(F=217.081、141.741、123.835,均P<0.05);CD4+、CD4+/CD8+与心功能分级呈负相关(r=-0.482、-0.849,均P<0.05),CD8+与心功能分级呈正相关(r=0.948,P<0.05);使用T淋巴细胞亚群的变化对心功能分级进行诊断的效果较高,AUC为0.984。结论:对慢性心力衰竭射血分数保留老年患者的心功能分级使用淋巴细胞亚群检测的准确率较高,值得推广。

Objective to analyze the relationship between the changes of lymphocyte subsets and cardiac function classification in elderly patients with chronic heart failure and preserved ejection fraction.Methods A total of 835 elderly patients with preserved ejection fraction treated in our hospital from August 2022 to June 2023 were retrospectively selected,and divided into gradeⅠ(302 cases),gradeⅡ(254 cases),gradeⅢ(144 cases)and gradeⅣ(135 cases)according to the cardiac function classification,and 211 cases in the same period were selected as the control group.The general data of patients were collected,and the expression of T lymphocyte subsets and serum levels of cardiac related factor in patients with different cardiac function classifications were compared and analyzed.Results There were no statistically significant differences in age,gender,BMI,systolic blood pressure,diastolic blood pressure and heart rate between the two groups(P>0.05).The lower the cardiac function classification,the higher the levels of CD4+[gradeⅠ:(39.7±8.0)%,gradeⅡ:(36.9±8.3)%,gradeⅢ:(32.1±6.5)%,gradeⅣ:(31.3±5.1)%],CD4+/CD8+[gradeⅠ:(1.8±0.5),gradeⅡ:(1.5±0.5),gradeⅢ:(1.4±0.5),gradeⅣ:(1.1±0.3)],and the lower the levels of CD8+[gradeⅠ:(23.9±5.1)%,gradeⅡ:(25.5±8.4)%,gradeⅢ:(26.3±10.0)%,gradeⅣ:(30.7±9.0)%]in T lymphocyte subsets(F=56.846,84.154,23.965,P<0.05);the lower the levels of sST2,GAL-3 and GDF-15 in serum of patients with lower cardiac function classification(F=217.081,141.741,123.835,P<0.05);CD4+and CD4+/CD8+were negatively correlated with cardiac function grading(r=-0.482 and r=-0.849,P<0.05),CD8+was positively correlated with cardiac function grading(r=0.948,P<0.05);the effect of using T lymphocyte subsets to diagnose cardiac function grading was higher and the AUC was 0.984.Conclusions The accuracy of lymphocyte subsets in the diagnosis of cardiac function grading in elderly patients with chronic heart failure and preserved ejection fraction is higher,which is worthy of promotion.