血清ATX、Adropin与扩张型心肌病患者炎症因子及预后不良的关系分析

Analysis of the relationship between serum ATX,Adropin and inflammatory factors and poor prognosis in patients with dilated cardiomyopathy

目的探讨血清自分泌运动因子(ATX)、能量平衡相关蛋白(Adropin)与扩张型心肌病(DCM)患者炎症因子及预后不良的关系。方法选取2017年6月至2020年2月青岛市黄岛区中医医院收治的DCM患者105例作为DCM组,另选取同期来该院体检的健康志愿者100例作为对照组。检测两组血清ATX、Adropin及炎症因子[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)]水平,并采用Pearson相关性分析法分析血清ATX、Adropin与炎症因子的相关性。DCM组患者根据随访期间有无发生终点事件分为预后良好组和预后不良组。Logistic回归分析DCM患者预后不良的危险因素,受试者工作特征(ROC)曲线分析血清ATX、Adropin对DCM患者预后不良的预测价值。结果DCM组血清ATX、hs-CRP、IL-6水平均高于对照组,Adropin水平低于对照组,差异有统计学意义(P<0.05)。Pearson相关性分析显示,血清ATX水平与hs-CRP及IL-6呈正相关,血清Adropin水平与hs-CRP及IL-6呈负相关(P<0.05)。预后不良组美国纽约心脏病学会(NYHA)心功能分级Ⅲ~Ⅳ级占比、血清ATX水平高于预后良好组,心力衰竭病程及左心室舒张末内径均大于预后良好组,左心室射血分数(LVEF)及血清Adropin水平低于预后良好组,差异有统计学意义(P<0.05)。Logistic回归模型分析发现,NYHA心功能分级Ⅲ~Ⅳ级、高ATX为导致DCM患者预后不良的危险因素,高Adropin、高LVEF为DCM患者预后不良的保护因素(P<0.05)。ROC曲线分析显示,血清ATX、Adropin预测DCM患者预后不良的曲线下面积(AUC)分别为0.841、0.793,二者联合预测DCM患者预后不良的AUC大于单独预测。结论DCM患者血清ATX异常升高,血清Adropin异常降低,二者与炎症因子密切相关,检测血清ATX、Adropin水平可为DCM患者预后评估提供参考。

Objective To investigate the relationship between serum autotaxin(ATX),energy balance related protein(Adropin)and inflammatory factors and poor prognosis in patients with dilated cardiomyopathy(DCM).Methods A total of 105 DCM patients admitted to Qingdao Huangdao District Traditional Chinese Medicine Hospital from June 2017 to February 2020 were selected as the DCM group,and 100 healthy volunteers who came to the hospital for physical examination during the same period were selected as the control group.The levels of serum ATX,Adropin and inflammatory factors[hypersensitive C-reactive protein(hs-CRP)and interleukin-6(IL-6)]in the two groups were detected,and the correlation between serum ATX,Adropin and inflammatory factors was analyzed by Pearson correlation analysis.Patients in DCM group were divided into good prognosis group and poor prognosis group according to the occurrence of endpoint events during follow-up.Logistic regression was used to analyze the risk factors of poor prognosis in DCM patients,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum ATX and Adropinfor poor prognosis in DCM patients.Results The serum levels of ATX,hs-CRP and IL-6 in DCM group were higher than those in control group,and the level of Adropin was lower than that in control group,with statistical significance(P<0.05).Pearson correlation analysis showed that serum ATX level was positively correlated with hs-CRP and IL-6,and serum Adropin level was negatively correlated with hs-CRP and IL-6(P<0.05).New York Heart Association(NYHA)functional classificationⅢtoⅣand serum ATX level in the poor prognosis group were higher than those in the good prognosis group,the heart failure duration and left ventricular end-diastolic diameter were higher than those in the good prognosis group,the left ventricular ejection fraction(LVEF)and serum Adropin levels were lower than those in the good prognosis group,the difference was statistically significant(P<0.05).Logistic regression model analysis showed that NYHA functional classificationⅢtoⅣand high ATX were risk factors for poor prognosis in DCM patients,and high Adropin and high LVEF were protective factors for poor prognosis in DCM patients(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of serum ATX and Adropin in predicting poor prognosis of DCM patients was 0.841 and 0.793,respectively,and the AUC of combined prediction of poor prognosis of DCM patients was greater than that of single prediction.Conclusion Serum ATX is abnormally elevated and serum Adropin is abnormally decreased in DCM patients,both of which are closely related to inflammatory factors.Detection of serum ATX and Adropin levels can provide reference for prognosis assessment of DCM patients.