老年慢性心力衰竭患者血清卵泡抑素样蛋白1、Dickkopf相关蛋白3水平与心室重构及预后的关系

Relationship between serum levels of follistatin-like protein 1 and Dickkopf related protein 3 with ventricular remodeling and prognosis in elderly patients with chronic heart failure

目的探讨老年慢性心力衰竭(CHF)患者血清卵泡抑素样蛋白1(FSTL-1)、Dickkopf相关蛋白3(DKK3)水平与心室重构及预后的关系。方法选取庐江县中医院2020年3月至2022年3月收治的142例老年CHF患者为研究对象(CHF组),根据纽约心脏协会(NYHA)心功能分级将CHF患者分为Ⅱ级(61例)、Ⅲ级(46例)、Ⅳ级(35例),根据随访结果将CHF患者分为预后不良组(48例)和预后良好组(94例)。另将同期在我院体检健康者142例作为对照组。ELISA法测定血清FSTL-1、DKK3水平;彩色多普勒超声测定患者心功能指标。比较CHF组与对照组、不同心功能分级及不同预后CHF患者血清FSTL-1、DKK3水平;血清FSTL-1、DKK3水平与心功能指标间的关系采用Pearson相关性分析;CHF患者发生预后不良的影响因素采用Logistic回归分析;采用ROC曲线分析血清FSTL-1、DKK3对老年CHF患者预后不良的预测价值。结果CHF组患者血清FSTL-1水平、左心室舒张末期内径(LVEDD)、左心房内径(LAD)、左心室质量指数(LVMI)高于对照组,左心室射血分数(LVEF)及血清DKK3水平低于对照组,差异有统计学意义(t=35.771、39.686、25.148、14.262、35.767、18.208,P<0.05)。随着NYHA分级的增加,CHF患者血清FSTL-1水平及LVEDD、LAD、LVMI逐渐增加(F=86.720,239.493、114.340、16.883,P<0.05),血清DKK3及LVEF逐渐降低(F=89.083、217.157,P<0.05)。Pearson相关性分析结果显示,血清FSTL-1与LVEDD、LAD、LVMI均呈正相关(r=0.630、0.568、0.404,P<0.01),与LVEF呈负相关(r=-0.642,P<0.01);血清DKK3与LVEDD、LAD、LVMI均呈负相关(r=-0.580、-0.593、-0.467,P<0.01),与LVEF呈正相关(r=0.621,P<0.01)。多因素Logistic回归分析结果显示,心功能分级、LVEF、LVEDD、LAD、LVMI、FSTL-1、DKK3均是CHF患者发生预后不良的影响因素[OR(95%CI)=1.422(1.043~1.938)、0.621(0.401~0.961)、1.353(1.024~1.787)、1.227(1.023~1.472)、1.531(1.159~2.022)、1.472(1.095~1.979)、0.724(0.544~0.964),P<0.05]。ROC曲线结果显示,血清FSTL-1联合DKK3预测老年CHF患者预后不良的敏感度和特异度分别为86.8%、82.4%,AUC为0.959,高于FSTL-1、DKK3单独检测(Z=2.300、2.006,P<0.05)。结论老年CHF患者血清FSTL-1、DKK3水平与心室重构和预后密切相关,两者有望成为临床评估老年CHF患者心室重构情况及预后的生物学指标。

Objective To investigate the relationship between serum levels of follistatin-like protein 1(FSTL-1)and Dickkopf related protein 3(DKK3)with ventricular remodeling and prognosis in elderly patients with chronic heart failure(CHF).Methods A total of 142 elderly patients with CHF admitted to Lujiang County Hospital of Traditional Chinese Medicine from March 2020 to March 2022 were selected as CHF group.According to the New York Heart Association(NYHA)cardiac function classification,the CHF patients were grouped into gradeⅡ(61 cases),gradeⅢ(46 cases),and gradeⅣ(35 cases).According to the follow-up results,the CHF patients were divided into poor prognosis group(48 cases)and good prognosis group(94 cases).Additionally,142 healthy individuals who underwent physical examinations at the hospital during the same period were included as the control group.ELISA method was applied to measure serum FSTL-1 and DKK3 levels.Color Doppler ultrasound was applied to measure cardiac function indexes.Serum levels of FSTL-1 and DKK3 were compared between the CHF group and the control group,among different heart function classifications,and between different prognostic outcomes of CHF patients.Pearson correlation was applied to analyze the relationship between serum FSTL-1 and DKK3 levels with cardiac function indicators.Logistic regression analysis was performed to analyze the influencing factors for poor prognosis in CHF patients.ROC curve was applied to assess the predictive value of serum FSTL-1 and DKK3 for poor prognosis in elderly CHF patients.Results Serum levels of FSTL-1,left ventricular end-diastolic diameter(LVEDD),left atrial diameter(LAD),and left ventricular mass index(LVMI)in the CHF group were higher compared to those in the control group,while left ventricular ejection fraction(LVEF)and serum levels of DKK3 were lower(t=35.771,39.686,25.148,14.262,35.767,18.208;P<0.05).With the increase in NYHA classification,serum levels of FSTL-1,LVEDD,LAD,and LVMI gradually increased in CHD patients(F=86.720,239.493,114.340,16.883;P<0.05),while serum levels of DKK3 and LVEF gradually decreased(F=89.083,217.157;P<0.05).Pearson correlation analysis showed that serum levels of FSTL-1 were positively correlated with LVEDD,LAD,and LVMI(r=0.630,0.568,0.404;P<0.01)and negatively correlated with LVEF(r=-0.642,P<0.01).Serum levels of DKK3 were negatively correlated with LVEDD,LAD,and LVMI(r=-0.580,-0.593,-0.467;P<0.01)and positively correlated with LVEF(r=0.621,P<0.01).Multivariate Logistic regression analysis showed that heart function classification,LVEF,LVEDD,LAD,LVMI,FSTL-1,and DKK3 were influencing factors for poor prognosis in CHF patients[OR(95%CI)=1.422(1.043-1.938),0.621(0.401-0.961),1.353(1.024-1.787),1.227(1.023-1.472),1.531(1.159-2.022),1.472(1.095-1.979),0.724(0.544-0.964);P<0.05].ROC curve analysis showed that the sensitivity and specificity of serum FSTL-1 combined with DKK3 in predicting poor prognosis in elderly CHF patients were 86.8%and 82.4%,respectively,with an AUC of 0.959,which was higher than that of FSTL-1 or DKK3 alone(Z=2.300,2.006;P<0.05).Conclusion Serum levels of FSTL-1 and DKK3 are closely related to ventricular remodeling and prognosis in elderly CHF patients.Both could potentially serve as biological indicators for the evaluation of ventricular remodeling and prognosis in clinical practice.