NT-proBNP、TSP-2、hs-CRP在非瓣膜性HFrEF患者中的表达及对短期预后的预测价值

Expression of NT⁃proBNP,TSP⁃2,and hs⁃CRP in patients with non⁃valvular HFrEF and their predictive value for short⁃term prognosis

目的探讨N端脑钠肽前体(NT-proBNP)、血小板吸附蛋白2(TSP-2)、超敏C反应蛋白(hs-CRP)在非瓣膜性射血分数降低心力衰竭(HFrEF)患者中的表达及对短期预后预测价值。方法选取2018年1月至2021年12月郑州大学第一附属医院收治的120例非瓣膜性HFrEF患者为HFrEF组,60例非瓣膜性射血分数保留心力衰竭(HFpEF)患者为HFpEF组,60例心功能正常心力衰竭(HF)患者为对照组。对比三组NT-proBNP、TSP-2、hs-CRP水平;根据心功能分级将HFrEF组患者分为心功能Ⅱ级、心功能Ⅲ级组、心功能Ⅳ级组,并对比三组NT-proBNP、TSP-2、hs-CRP水平;分析NT-proBNP、TSP-2、hs-CRP各指标之间的相关性;根据随访结果将HFrEF组患者分为预后良好组和预后不良组,并比较两组患者NT-proBNP、TSP-2、hs-CRP水平;分析影响HFrEF患者预后的多因素;分析NT-proBNP、TSP-2对HFrEF患者的短期预后预测价值。结果三组NT-proBNP、TSP-2、hs-CRP水平为:HFrEF组>HFpEF组>对照组,差异有统计学意义(P<0.05);120例非瓣膜性HFrEF患者中,心功能Ⅱ级38例(31.67%)、心功能Ⅲ级46例(38.33%)、心功能Ⅳ级36例(30.00%);三组NT-proBNP、TSP-2、hs-CRP水平为:心功能Ⅳ级组>心功能Ⅲ级组>心功能Ⅱ级组,差异有统计学意义(P<0.05);非瓣膜性HFrEF患者血清NT-proBNP与TSP-2、hs-CRP呈正相关(P<0.05);120例非瓣膜性HFrEF患者中,预后良好79例(65.83%)、预后不良41例(34.17%);患者NT-proBNP、TSP-2、hs-CRP水平为:预后不良组>预后良好组,差异有统计学意义(P<0.05);Logistic回归分析结果显示,NT-proBNP、TSP-2、hs-CRP高表达是非瓣膜性HFrEF患者预后不良的危险因素(P<0.05);NT-proBNP、TSP-2、hs-CRP单独与联合预测非瓣膜性HFrEF患者预后的AUC为0.779、0.907、0.898、0.948,联合预测的AUC高于NT-proBNP、TSP-2、hs-CRP,差异有统计学意义(P<0.05)。结论NT-proBNP、TSP-2、hs-CRP在非瓣膜性HFrEF患者中高表达,三指标联合检测能较好预测患者短期预后。

Objective To investigate the expression of N-terminal brain natriuretic peptide precur-sor(NT-proBNP),platelet adsorbed protein 2(TSP-2),and ultrasensitive C-reactive protein(hs-CRP)in pa-tients with nonvalvular heart failure with reduced ejection fraction(HFrEF)and their predictive value for short-term prognosis.Methods One hundred and twenty non-valvular HFrEF patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2021 were selected as the HFrEF group,60 non-valvular ejection fraction-preserved heart failure(HFpEF)patients were selected as the HFpEF group,and 60 patients with normal cardiac function in heart failure(HF)were selected as the control group.The NT-proBNP,TSP-2,and hs-CRP levels of patients in the three groups were tested and compared respectively.Pa-tients in the HFrEF group were divided into cardiac function classⅡ,cardiac function classⅢ,and cardiac func-tion classⅣgroups based on cardiac function classification,and the NT-proBNP,TSP-2,and hs-CRP levels of patients in the three groups were compared.The correlation between the NT-proBNP,TSP-2,and hs-CRP indi-cators was analyzed.The correlation between the NT-proBNP,TSP-2,and hs-CRP indicators was determined according to follow-up.The correlation between the NT-proBNP,TSP-2,and hs-CRP indicators was deter-mined according to follow-up.The multifactorial factors affecting the prognosis of HFrEF patients,and the short-term prognostic predictive value of NT-proBNP and TSP-2 for HFrEF patients were analyzed.Results The levels of NT-proBNP,TSP-2 and hs-CRP in the three groups were HFrEF group>HFpEF group>control group,and the difference was statistically significant(P<0.05).Among the 120 patients with non-valvular HFrEF,38 cases(31.67%)were in cardiac classⅡ,46 cases(38.33%)were in cardiac classⅢ,and 36 cases(30.00%)were in cardiac classⅣ(P<0.05).The levels of NT-proBNP,TSP-2 and hs-CRP in the three groups were in cardiac classⅣgroup>cardiac classⅢgroup>cardiac classⅡgroup,and the difference was statistically significant(P<0.05).Serum NT-proBNP was positively correlated with TSP-2 and hs-CRP in patients with non-valvular HFrEF(P<0.05).Out of 120 cases of non-valvular HFrEF patients,79 cases(65.83%)had a good prognosis and 41 cases(34.17%)had a poor prognosis.The levels of NT-proBNP,TSP-2,and hs-CRP in the patients were in the poor prognosis group>good prognosis group,and the difference was statistically significant(P<0.05).The results of logistic regression analysis showed that high expression of NT-proBNP,TSP-2,and hs-CRP was the main cause of non-valvular HFrEF.High CRP expression was a risk factor for poor prognosis in pa-tients with non-valvular HFrEF(P<0.05).The AUCs of NT-proBNP,TSP-2,and hs-CRP alone and in combi-nation for predicting prognosis in patients with nonvalvular HFrEF were 0.779,0.907,0.898,and 0.948,re-spectively,with the combined prediction being higher than that of NT-proBNP,TSP-2 and hs-CRP alone(P<0.05).Conclusion NT-proBNP,TSP-2 and hs-CRP are highly expressed in patients with non-valvular HFrEF.The combination of these biomarkers can better predict the short-term prognosis of patients.