血清鸢尾素联合可溶性Corin在老年慢性心力衰竭患者预后评估中的价值

Roles of serum irisin and soluble Corin in prognosis assessment of elderly patients with chronic heart failure

目的探讨血清鸢尾素和可溶性Corin在老年慢性心力衰竭(CHF)患者预后评估中的价值。方法选取2016年3月—2019年2月中国人民解放军北部战区总医院老年CHF患者129例。收集所有患者的临床资料,并检测血常规、生化常规指标和血清鸢尾素、可溶性Corin水平,以及左心室射血分数(LVEF)。对所有患者进行随访,随访终点为全因死亡或发生主要心血管不良事件。将发生终点事件的患者纳入预后不良组,未发生终点事件的患者纳入预后良好组。采用Pearson相关分析评估各项目的相关性。采用受试者工作特征(ROC)曲线确定血清鸢尾素和可溶性Corin判断老年CHF患者发生终点事件的最佳临界值并进行分组。采用Kaplan-Meier生存曲线分析老年CHF患者的生存情况。采用Cox回归分析评估老年CHF患者预后不良的危险因素。结果不同纽约心脏病协会(NYHA)分级的老年CHF患者之间临床特征差异均无统计学意义(P>0.05)。不同性别的老年CHF患者之间鸢尾素和可溶性Corin水平差异均无统计学意义(P>0.05)。血清鸢尾素和可溶性Corin与氨基末端B型钠尿肽原(NT-pro BNP)、LVEF均无相关性(P>0.05)。预后不良组血清鸢尾素和可溶性Corin水平均低于预后良好组(P<0.05)。鸢尾素>5.7 ng·m L^(–1)组和可溶性Corin>487 pg·m L^(–1)组无终点事件生存期分别显著长于鸢尾素≤5.7 ng·m L^(–1)组和可溶性Corin≤487 pg·m L^(–1)组(P<0.01)。年龄>70岁、合并心房颤动、NYHAⅡ~Ⅲ级、合并贫血、血肌酐(SCr)升高、NT-pro BNP>1000 pg·m L^(–1)、LVEF<50%、鸢尾素≤5.7 ng·m L^(–1)、可溶性Corin≤487 pg·m L^(–1)是老年CHF患者预后不良(发生主要心血管事件和全因死亡)的独立危险因素(P<0.05)。结论血清鸢尾素和可溶性Corin对老年CHF患者发生主要心血管不良事件和全因死亡具有较好的预测价值,或可作为老年CHF患者预后评估的指标。

Objective To investigate the roles of serum irisin and soluble Corin in prognosis assessment of elderly patients with chronic heart failure(CHF).Methods A total of 129 elderly patients with CHF were enrolled from the General Hospital of Chinese People's Liberation Army Northern Theater Command from March 2016 to February 2019.The clinical data of all the patients were collected,and blood routine test,routine biochemical parameters,serum irisin,soluble Corin levels and left ventricular ejection fraction(LVEF)were determined.All the patients were followed up,and the end point of follow-up was all-cause death or major adverse cardiovascular events.The patients with end point events were included in poor prognosis group,and those without end point events were included in good prognosis group.Pearson correlation was used to assess the correlation between indexes.Receiver operating characteristic(ROC)curve was used to determine the optimal cut-off value of serum irisin and soluble Corin to determine the end point events in elderly CHF patients.Kaplan-Meier survival curve was used to analyze the survival of elderly patients with CHF.Cox regression analysis was used to evaluate the risk factors of poor prognosis in elderly patients with CHF.Results There was no statistical significance in clinical data among elderly CHF patients with different New York Heart Association(NYHA)grades(P>0.05).There was no statistical significance in irisin and soluble Corin levels among elderly CHF patients of different genders(P>0.05).Serum irisin and soluble Corin had no correlation with N-terminal pro-B-type natriuretic peptide(NT-proBNP)and LVEF(P>0.05).The levels of serum irisin and soluble Corin in poor prognosis group were lower than those in good prognosis group(P<0.05).The free end point event survival times of irisin>5.7 ng·mL^(–1) group and soluble Corin>487 pg·mL^(–1) group were longer than those of irisin≤5.7 ng·mL^(–1) group and soluble Corin≤487 pg·mL^(–1) group,respectively(P<0.01).Age>70 years old,combined with atrial fibrillation,NYHAⅡ-Ⅲ,combined with anemia,elevated serum creatinine(SCr),NT-proBNP>1000 pg·mL^(–1),LVEF<50%,serum irisin≤5.7 ng·mL^(–1),soluble Corin≤487 pg·mL^(–1) were independent risk factors for poor prognosis(major adverse cardiovascular events and all-cause death)in elderly patients with CHF.Conclusions Serum irisin and soluble Corin have good predictive value for major adverse cardiovascular events and all-cause death in elderly patients with CHF,and may be used as prognostic indexes for elderly patients with CHF.