儿茶酚抑素在慢性心力衰竭患者预后中的临床意义

摘要

目的：探讨血浆儿茶酚抑素（CST）含量与慢性心力衰竭（CHF）患者预后的相关性。方法2009年1月-2012年1月诊治CHF患者128例。入院后收集患者相关临床资料及用药情况，测定血浆CST水平，并对患者出院后常规随访18个月，失访8例，依据随访期内出现主要心血管不良事件（MACE）与否分为MACE组（ n ＝84）与非MACE 组（ n ＝36），对2组患者的临床资料进行统计学分析，以探寻CST对于CHF患者MACE的预测价值。结果2组患者性别、收缩压、血肌酐（ SCr）、左心室射血分数（ LVEF）、左心室舒张末期内径（ LVEDD）、心率（ HR）、N-末端脑钠肽前体（ NT-proBNP）及CST比较差异有统计学意义（ P均＜0浇．05）。多因素Logistic回归分析显示CST、NT-proB-NP、LVEF、LVEDD是CHF患者18个月内发生MACE的独立危险因素（ P ＜0．05）。 MACE组CST 水平与NTp-roBNP水平呈正相关（ r ＝06．97， P ＜0．05），与LVEF 呈负相关（ r ＝-0．784， P ＜0．05）。使用ROC曲线判定CST预测CHF患者18个月内发生MACE的几率，其曲线下面积（AUC）为0．836（95％CI 0．774～0．886， P ＜0．05），CST水平为0．83μg/L时预测价值最高，灵敏度为69．41％，特异度为82．22％。 Kaplan-Meier生存曲线提示CST 水平≥0．83μg/L的CHF患者MACE发生率高于CST水平＜0．83μg/L者（χ2＝3．89， P ＜00．5）。结论血浆CST水平升高是CHF患者18个月内发生MACE的独立危险因素，CST水平可对CHF 患者的预后转归进行有效预测。%Objective To investigate the correlation between plasma catestatin ( CST) levels and prognosis of chronic heart failure (CHF) patients.Methods From 2009 January to 2012 January, 128 patients with CHF were enrolled .After ad-mission, the clinical data and drug use , the determination of plasma CST level were collected , and the patients were routine follow-up of 18 months, 8 cases were lost of follow-up, mainly on the basis of cardiovascular adverse events occurred during the follow-up period (MACE), patients were divided into MACE group ( n =84) and non-MACE group ( n =36), the clini-cal data of 2 groups were analyzed to explore the predictive value of CST for patients with CHF .Results 2 groups'sex, systo-lic blood pressure, serum creatinine (SCr), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), heart rate (HR),N-terminal pro brain natriuretic peptide (NT-proBNP) and CST comparison was statistically sig-nificant different ( P <0.05).Multivariate Logistic regression analysis showed that CST , NT-proBNP, LVEF, LVEDD are the independent risk factors of MACE for CHF patients within 18 month ( P <0.05).MACE group's CST level was positively correlated with NTp-roBNP levels ( r =0.697, P <0.05), and negatively correlated with LVEF ( r =-0.784, P <0.05). Using the ROC curve to evaluate CST predict MACE probability of patients with CHF within 18 months, the area under the ROC curve (AUC) was 0.836 (95%CI 0.774-0.886, P <00.5 ), CST level was 0.83 μg/L revealed the highest predic-tive value,the sensitivity was 69.41%, specificity was 82.22%.Kaplan-Meier survival curves indicated that CST level ≥0.83 μg/L, MACE incidence was higher than that of CST level <0.83 μg/L in patients with CHF (χ2 =3.89, P<0 .05). Conclusion Elevated plasma CST levels are independent risk factors of MACE for CHF patients within 18 months, CST level to predict CHF patient 's prognosis were effective .