老年心力衰竭伴心房颤动患者外周血SAA、ANGPTL3、TLR4变化及与预后的关系

Changes of peripheral blood SAA,ANGPTL3 and TLR4 in elderly patients with heart failure and atrial fibrillation and their relationship with the prognosis

目的探究老年心力衰竭(HF)伴心房颤动(AF)患者外周血淀粉样蛋白A(SAA)、血管生成素样蛋白3(ANGPTL3)、Toll样受体4(TLR4)变化及与预后的关系。方法选择2020年8月至2023年8月期间于邯郸市第一医院就诊并接受治疗的186例老年HF伴AF患者为观察组,按照心功能分为轻度组、中重度组,按照预后分为预后良好组和预后不良组,另选取同期100名健康体检者为对照组。比较观察组和对照组、轻度组和中重度组、预后不良组和预后良好组之间的SAA、ANGPTL3、TLR4水平差异。采用Pearson相关系数分析SAA、ANGPTL3、TLR4之间的相关性,采用受试者工作特征(ROC)曲线分析外周血SAA、ANGPTL3、TLR4对老年HF伴AF患者预后的预测价值。结果观察组外周血SAA、ANGPTL、TLR4水平高于对照组,差异有统计学意义(P<0.05)。中重度组外周血SAA、ANGPTL、TLR4水平高于轻度组,差异有统计学意义(P<0.05)。186例老年HF伴AF患者中预后不良者52例,预后不良组外周血SAA、ANGPTL、TLR4水平高于预后良好组,差异有统计学意义(P<0.05)。Pearson相关分析结果显示,SAA与ANGPTL3、TLR4呈正相关(r=0.482、0.427,P<0.001),ANGPTL3与TLR4呈正相关(r=0.513,P<0.001)。外周血SAA、ANGPTL3、TLR4水平及联合检测预测预后的AUC为0.832、0.810、0.842、0.926。结论老年HF伴AF患者外周血SAA、ANGPTL3、TLR4水平明显升高,三指标在老年HF伴AF患者的预后预测中具有重要临床意义,且联合预测效能更高。

Objective To investigate the changes of peripheral blood amyloid A(SAA),angio-poietin-like 3(ANGPTL3)and Toll-like receptor 4(TLR4)in elderly patients with heart failure(HF)and atrial fibrillation(AF),and their relationship with the prognosis.Methods A total of 186 elderly patients with HF and AF who were treated at Handan First Hospital from August 2020 to August 2023 were selected as the observation group.They were divided into the mild group and the moderate-severe group based on cardiac function,and divided into the good prognosis group and the poor prognosis group according to the prognosis.At the same time,100 healthy individuals were selected as the control group.The levels of SAA,ANGPTL3 and TLR4 were compared between the observation group and the control group,between the mild group and the moderate-severe group,as well as between the poor prognosis group and the good prognosis group.Pear-son correlation analysis was performed to analyze the correlation of SAA,ANGPTL3 and TLR4.The receiver operating characteristic(ROC)curves were used to analyze the prognostic value of peripheral blood SAA,ANGPTL3,and TLR4 in elderly patients with HF and AF.Results Peripheral blood levels of SAA,ANGPTL3,and TLR4 in the observation group were higher than those in the control group(P<0.05).Levels of peripheral blood SAA,ANGPTL3,and TLR4 levels in the moderate-severe group were higher than those in the mild group(P<0.05).Peripheral blood SAA,ANGPTL3 and TLR4 levels in the poor prognosis group were higher than those in the good prognosis group(P<0.05).Pearson correlation analysis results showed that SAA was positive correlated with ANGPTL3 and TLR4(r=0.482 and 0.427,P<0.001),ANGPTL3 was posi-tive correlated with TLR4(r=0.513,P<0.001).The AUC values of peripheral blood SAA,ANGPTL3,TLR4,and their combination for prognosis were 0.832,0.810,0.842 and 0.926.Conclusion Peripheral blood SAA,ANGPTL3,and TLR4 levels are significantly increased in elderly patients with HF and AF.The three indicators hold great clinical significance in predicting the prognosis of elderly patients with HF and AF,and combining the three can lead to achieve better performance.