彩色多普勒超声联合血清Cyr61、ANGPTL3对慢性心力衰竭患者的诊断价值

Diagnostic value of color Doppler ultrasound combined with serum Cyr61 and ANGPTL3 in patients with chronic heart failure

目的探究彩色多普勒超声(CDU)联合血清富含半胱氨酸蛋白61(Cyr61)、血管生成素样蛋白3(ANGPTL3)对慢性心力衰竭(CHF)患者的诊断价值。方法选取2020年12月—2023年12月西北大学附属医院·西安市第三医院心内科收治的CHF患者86例为心力衰竭组,根据美国纽约心脏协会(NYHA)心功能分级,将患者分为Ⅱ~Ⅲ级亚组58例和Ⅳ级亚组28例。另选取同期医院健康体检者86例为健康对照组。采用CDU检测心功能,酶联免疫吸附法(ELISA)测定血清Cyr61、ANGPTL3水平;Pearson相关分析血清Cyr61、ANGPTL3水平与心功能指标的相关性;多因素Logistic回归分析CHF患者的影响因素;受试者工作特征(ROC)曲线评价CDU及血清Cyr61、ANGPTL3水平对CHF的诊断价值。结果心力衰竭组血清Cyr61、ANGPTL3水平及左心室舒张末期内径(LVEDD)、左心房内径(LAD)均显著高于健康对照组,左心室射血分数(LVEF)显著低于健康对照组(t/P=9.779/<0.001、35.751/<0.001、18.376/<0.001、21.451/<0.001、49.742/<0.001);Ⅳ级亚组CHF患者血清Cyr61、ANGPTL3水平及LVEDD、LAD均显著高于Ⅱ~Ⅲ级亚组,LVEF显著低于Ⅱ~Ⅲ级亚组(t/P=11.226/<0.001、37.440/<0.001、7.786/<0.001、27.001/<0.001、13.303/<0.001);血清Cyr61、ANGPTL3水平与LVEDD、LAD呈正相关,与LVEF呈负相关(Cyr61:r/P=0.501/<0.001、0.510/<0.001、-0.522/<0.001;ANGPTL3:r/P=0.515/<0.001、0.517/<0.001、-0.532/<0.001);多因素Logistic回归分析显示,Cyr61、ANGPTL3、LVEDD、LAD升高为CHF患者的独立危险因素[OR(95%CI)=3.108(1.590~6.076)、4.378(2.011~9.533)、3.420(1.452~8.054)、2.058(1.429~2.963)],LVEF升高为独立保护因素[OR(95%CI)=0.521(0.329~0.824)];LVEDD、LAD、LVEF、Cyr61、ANGPTL3及五者联合诊断CHF的曲线下面积(AUC)分别为0.764、0.832、0.815、0.810、0.808、0.976,五者联合的AUC大于单独诊断的AUC(Z/P=2.527/0.031、2.675/0.024、2.689/0.020、2.679/0.018、2.680/0.023)。结论CHF患者血清Cyr61、ANGPTL3均显著升高,CDU联合血清Cyr61、ANGPTL3可提高对CHF患者的诊断价值。

Objective To explore the diagnostic value of color Doppler ultrasound(CDU)combined with serum cysteine-rich 61(Cyr61)and angiopoietin like protein 3(ANGPTL3)in patients with chronic heart failure(CHF).Methods Eighty-six cases of CHF patients admitted to the Department of Cardiology of the Northwest University Affiliated Hospital Xi'an No.3 Hospital,from December 2020 to December 2023 were selected as the study group,and the patients were divided into 58 cases of subgroups of classⅡ-Ⅲand 28 cases of subgroup of classⅣaccording to the cardiac function grading of the New York Heart Association(NYHA).Another 86 cases were selected as healthy control group from the same period of hospital health checkups.Enzyme-linked immunosorbent assay(ELISA)was used to determine serum Cyr61 and ANGPTL3 levels;Pearson correlation analysis was used to analyze the correlation between serum Cyr61 and ANGPTL3 levels and cardiac function indexes;multifactorial logistic regression was used to analyze the influencing factors of CHF patients;and subjects'work characteristics(ROC)curves were used to evaluate the CDU and serum Cyr61,ANGPTL3 levels for the diagnostic value of CHF.Results Serum Cyr61,ANGPTL3 levels and left ventricular end-diastolic internal diameter(LVEDD)and left atrial diameter(LAD)were significantly higher and left ventricular ejection fraction(LVEF)was significantly lower in the study group than in the healthy control group(t/P=9.779/<0.001,35.751/<0.001,18.376/<0.001,21.451/<0.001,49.742/<0.001);serum Cyr61 and ANGPTL3 levels and LVEDD and LAD were significantly higher in the class IV subgroup of CHF patients than in the classⅡ-Ⅲsubgroup,and LVEF was significantly lower than in the classⅡ-Ⅲsubgroup(t/P=11.226/<0.001,37.440/<0.001,7.786/<0.001,27.001/<0.001,13.303/<0.001);serum Cyr61 and ANGPTL3 levels were positively correlated with LVEDD and LAD and negatively correlated with LVEF(r/P=0.501/<0.001,0.510/<0.001,-0.522/<0.001,0.515/<0.001,0.517/<0.001,-0.532/<0.001);multifactorial logistic regression analysis showed that high Cyr61,high ANGPTL3,high LVEDD,and high LAD were independent risk factors for patients with CHF[OR(95%CI)=3.108(1.590-6.076),4.378(2.011-9.533),3.420(1.452-8.054),2.058(1.429-2.963)],and high LVEF was an independent protective factor[OR(95%CI)=0.521(0.329-0.824)];the AUCs for the diagnosis of CHF for LVEDD,LAD,LVEF,Cyr61,ANGPTL3 and the combination of the five were:0.764,0.832,0.815,0.810,0.808,and 0.976,and the area under the curve(AUC)of the combination of the five was greater than the AUC of LVEDD,LAD,LVEF,Cyr61,and ANGPTL3 diagnosed alone(Z/P=2.527/0.031,2.675/0.024,2.689/0.020,2.679/0.018,2.680/0.023).Conclusion Serum Cyr61 and ANGPTL3 are greatly elevated in CHF patients,and CDU combined with serum Cyr61 and ANGPTL3 can improve the diagnostic value for CHF patients.