充血性心力衰竭患者血浆galectin-3水平变化及临床意义

摘要

目的 分析充血性心力衰竭(心衰)患者血浆半乳糖凝集素-3(galectin-3)水平变化及临床意义.方法 选取2013年2月~2015年2月于河北省人民医院收治的充血性心衰患者300例,纳入观察组,男性182例,女性118例,年龄44~78岁,平均年龄(60.2±11.3)岁.另取同期健康体检者100例纳入对照组,男性62例,女性38例,年龄43~79岁,平均年龄(60.8±11.2)岁.采用酶联免疫吸附法检测两组血浆galectin-3、脑钠肽(BNP)水平,采用超声心动图检测左室舒张末期内径(LVEDD)、左房舒张末期内径(LADD)、左室射血分数(LVEF)、左室短轴缩短率(LVFS).根据纽约心脏协会(NYHA)心功能分级分为Ⅱ级(112例)、Ⅲ级(96例)和Ⅳ级(92例).所有患者随访2年,记录存活与死亡情况以及galectin-3水平.结果 观察组患者galectin-3、BNP、LVEDD、LADD水平分别为(15.2±2.8)ng/ml、(672.3±247.9)pg/ml、(64.9±4.8)mm、(45.7±8.2)mm,均显著高于对照组的(10.7±3.2)ng/ml、(75.6±33.4)pg/ml、(46.7±3.2)mm、(28.8±2.7)mm,而LVEF、LVFS水平分别为(37.1±7.3)%、(18.6±5.2)%,均低于对照组的(68.4±5.5)%、(39.2±3.6)%,差异有统计学意义(P均<0.01).NYHA分级Ⅲ级、Ⅳ级患者的血浆galectin-3、LVEDD、LADD水平均显著高于Ⅱ级患者,而LVEF、LVFS水平均显著低于Ⅱ级患者,且随着NYHA分级增加BNP呈上升趋势,差异均有统计学意义(P均<0.05).相关性分析可得,充血性心衰患者的血浆galectin-3与NYHA分级、BNP、LVEDD、LADD均呈正相关(r=0.532、0.574、0.478、0.685,P均<0.05),与LVEF、LVFS均呈负相关(r=-0.586、-0.598,P均<0.05).存活组患者的血浆galectin-3水平为(14.0±3.4)ng/mL,显著低于死亡组的(15.8±4.1)ng/mL,差异有统计学意义(P<0.05).结论 充血性心力衰竭患者血浆galectin-3水平明显升高,且与心脏结构和功能指标相关,与患者预后也有一定关联.%Objective To analyze the changes and clinical significance of plasma galectin-3 in patients with congestive heart failure (CHF). Methods CHF patients (n=300, male 182, female 118, aged from 44 to 78 and average age=60.2±11.3) were chosen into observation group from People's Hospital of Hebei Province from Feb. 2013 to Feb. 2015. Meanwhile healthy cases (n=100, male 62, female 38, aged from 43 to 79 and average age=60.8±11.2) were chosen into control group. The levels of galectin-3 and BNP were detected by using ELISA. The left ventricular end-diastolic inner diameter (LVEDd), left atrial diastolic diameter (LADd), left ventricular ejection fraction (LVEF) and left ventricular fraction shortening (LVFS) were detected by using echocardiogram. According to NYHA, there were 112 patients in grade Ⅱ group, 96 in Ⅲ grade group and 92 in Ⅳ grade group. All patients were followed up for 2 y to record survival or death status and galectin-3 level. Results The levels of galectin-3, BNP, LVEDd and LADd were, respectively, (15.2±2.8) ng/ml, (672.3±247.9) pg/ml, (64.9±4.8) mm and (45.7±8.2) mm in observation group, and (10.7±3.2) ng/ml, (75.6±33.4) pg/ml, (46.7±3.2) mm and (28.8±2.7) mm in control group. The levels of LVEF and LVFS were, respectively, (37.1±7.3)% and (18.6±5.2)% in observation group, and (68.4±5.5)% and (39.2±3.6)% in control group (all P<0.01). The levels of galectin-3, LVEDd and LADd were significantly higher, and levels of LVEF and LVFS were significantly lower in grade Ⅲ group and grade Ⅳ group than those in grade Ⅱ group, and BNP level showed an ascending trend along with NYHA grades increased (all P<0.05). The results of correlation analysis showed that galectin-3 was positively correlated to NYHA grades, BNP, LVEDd and LADd (r=0.532, 0.574, 0.478, 0.685, P均<0.05), and was negatively correlated to LVEF and LVFS (r=-0.586,-0.598, P均<0.05). The level of plasma galectin-3 was (14.0±3.4) ng/ml in survival group and (15.8±4.1) ng/mL in death group (P<0.05). Conclusion The level of galectin-3 increases significantly, and is correlated to cardiac structure, functional indexes and prognosis in CHF patients.