老年心力衰竭住院患者犬尿氨酸和色氨酸与短期预后的关系探索

Relationship between kynurenine/tryptophan ratio and short-term prognosis in elderly inpatients with heart failure

目的 探讨心力衰竭住院患者犬尿氨酸/色氨酸比值波动及其与短期预后的关系。方法 回顾性选取2020年12月至2022年12月长沙市第一医院收治的心力衰竭住院患者150例,根据患者出院后6个月预后情况分为预后不良组48例和预后良好组102例。采用液相色谱-串联质谱法测定患者血清中犬尿氨酸、色氨酸浓度,比较2组患者入院时、出院时犬尿氨酸/色氨酸比值,采用ROC曲线分析犬尿氨酸/色氨酸比值对心力衰竭住院患者短期预后的预测价值,采用logistic回归分析心力衰竭住院患者出院后6个月发生不良事件的影响因素。结果 预后不良组总胆固醇低于预后良好组,B型钠尿肽、尿素高于预后良好组(P<0.05)。2组出院时犬尿氨酸/色氨酸比值均低于入院时(P<0.01);预后不良组出院时犬尿氨酸/色氨酸比值高于预后良好组(P<0.01)。ROC曲线分析显示,入院时、出院时犬尿氨酸/色氨酸比值预测心力衰竭住院患者短期预后的曲线下面积分别为0.863(95%CI:0.803~0.924)、0.701(95%CI:0.602~0.801),出院时犬尿氨酸/色氨酸比值预测效能高于入院时(P<0.05)。多因素logistic回归分析显示,总胆固醇(OR=0.696,95%CI:0.501~0.965)、B型钠尿肽(OR=1.530,95%CI:1.092~2.143)、尿素(OR=1.740,95%CI:1.077~2.813)、出院时犬尿氨酸/色氨酸比值(OR=2.280,95%CI:1.093~4.754)是心力衰竭住院患者出院6个月发生不良事件的影响因素(P<0.05)。结论 犬尿氨酸/色氨酸比值是心力衰竭住院患者短期不良预后的独立危险因素,且可有效预测短期预后情况。

Objective To investigate the fluctuation of kynuridine/tryptophan ratio and its relationship with short-term prognosis in hospitalized patients with HF.Methods A total of 150 elderly HF patients admitted to our hospital from December 2020 to December 2022 were enrolled,and according to their clinical outcomes in 6 months after discharge,they were divided into poor prognosis group(n=48) and good prognosis group(n=102).The concentrations of kynurenine and tryptophan in serum were determined by liquid chromatography-tandem mass spectrometry.The kynuridine/tryptophan ratio at admission and discharge was compared between the two groups.ROC curve was plotted to evaluate the value of the ratio in predicting the short-term prognosis in the patients.Logistic regression analysis was used to identify the influencing factors for adverse events in these inpatients in 6 months after discharge.Results The poor prognosis group had significantly lower levels of TC,BNP and BUN than the good prognosis group(P<0.05).The kynuridine/tryptophan ratio was obviously lower at discharge than at admission in both groups(P<0.01),and the ratio in the poor prognosis group at discharge was notably higher than that in the good prognosis group(P<0.01).ROC curve analysis showed that the AUC value of kynuridine/tryptophan ratio at admission and discharge in predicting short-term prognosis of the HF inpatients was 0.863(95%CI:0.803-0.924) and 0.701(95%CI:0.602-0.801),respectively,with the predictive performance of the ratio at discharge higher than that at admission(P<0.05).Multivariate logistic regression analysis indicated that TC(OR=0.696,95%CI:0.501-0.965),BNP(OR=1.530,95%CI:1.092-2.143),BUN(OR=1.740,95%CI:1.077-2.813) and the kynuridine/tryptophan ratio at discharge(OR=2.280,95%CI:1.093-4.754) were the influencing factors of adverse events in the elderly HF inpatients in 6 months after discharge(P<0.05).Conclusion Kynurenine/tryptophan ratio is an independent risk factor for short-term poor prognosis in hospitalized HF patients,and it can effectively predict short-term prognosis of the patients.