sTWEAK在慢性心力衰竭患者外周血中的表达及对近期MACE的预测价值
|
摘要
目的探讨血浆可溶性肿瘤坏死因子样凋亡微弱诱导因子(sTWEAK)在慢性心力衰竭(CHF)患者中的表达特征以及对短期预后的预测价值。方法选择2016年1月至2017年1月于三门峡市第三人民医院心内科就诊的CHF患者161例,另选30例健康志愿者作为对照组,比较两组患者实验室生化指标和心功能的差异。并采用受试者工作特征(ROC)曲线确定CHF患者血浆sTWEAK的cut-off值,根据cut-off值,将CHF患者分为低水平组和高水平组。随访1年,采用Kaplan-Meier生存曲线分析两亚组患者发生主要不良心血管事件(MACE)的时间差异,包括全因死亡、急性心力衰竭、急性心肌梗死、不稳定型心绞痛。结果入院次日,CHF患者血浆sTWEAK基线水平明显低于对照组受试者(P<0.05)。经Spearman相关性分析,CHF患者血浆sTWEAK与N末端脑钠肽前体(NT-proBNP)呈正相关性(r=0.479,P<0.05)。经ROC曲线下的面积为0.670,血浆sTWEAK诊断CHF发生的cut-off值为192.74pg/ml(P=0.021)。72例患者为sTWEAK高水平组(>192.74 pg/ml),89例患者为低水平组(≤192.74pg/ml),平均随访(10.78±2.45)个月,sTWEAK高水平组患者MACE发生率明显高于低水平组(P<0.05)。另外,经Kaplan-Meier生存曲线分析,sTWEAK高水平组患者短期内MACE发生风险明显高于低水平组(P<0.05)。结论慢性心力衰竭患者外周血sTWEAK水平低于健康受试者,对慢性心力衰竭患者短期内主要不良事件的发生风险具有一定的预测价值。
Objective To investigate the expression characteristics of plasma soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK) in patients with chronic heart failure(CHF) and its predictive value for shortterm prognosis. Methods 161 patients with CHF who were admitted to the Department of Cardiology of Sanmenxia Third People's Hospital from January 2016 to January 2017 were selected. Another 30 healthy volunteers were selected as the control group. The biochemical parameters and cardiac function of the two groups were compared. The receiver operating characteristic(ROC) curve was used to determine the cut-off value of plasma sTWEAK in CHF patients. According to the cut-off value, CHF patients were divided into low level group and high level group. After1 year of follow-up, Kaplan-Meier survival curves were used to analyze the time differences between major adverse cardiovascular events(MACE) in the two subgroups, including all-cause death, acute heart failure, acute myocardial infarction, and unstable angina. Results On the next day of admission, the baseline level of plasma sTWEAK in patients with CHF was significantly lower than that in the control group(P<0.05). According to Spearman correlation analysis, plasma sTWEAK was positively correlated with N-terminal brain natriuretic peptide(NT-proBNP) in patients with CHF(r=0.479, P<0.05). The area under the ROC curve was 0.670, and the cut-off value of plasma s TWEAK for the diagnosis of CHF was 192.74 pg/ml(P=0.021). Seventy-two patients were in the sTWEAK high-level group(>192.74 pg/ml), 89 patients in the low-level group(≤192.74 pg/ml), and the mean follow-up(10.78±2.45)months. The incidence of MACE was significantly higher in the sTWEAK high-level group than in the low-level group(P<0.05). According to Kaplan-Meier survival curve analysis, the risk of MACE in the sTWEAK high-level group was significantly higher than that in the low-level group(P<0.05). Conclusion The level of sTWEAK in peripheral blood of patients with chronic heart failure is lower than that of healthy subjects, and it has certain predictive value for the risk of major adverse events in patients with chronic heart failure in the short term.
Objective To investigate the expression characteristics of plasma soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK) in patients with chronic heart failure(CHF) and its predictive value for shortterm prognosis. Methods 161 patients with CHF who were admitted to the Department of Cardiology of Sanmenxia Third People's Hospital from January 2016 to January 2017 were selected. Another 30 healthy volunteers were selected as the control group. The biochemical parameters and cardiac function of the two groups were compared. The receiver operating characteristic(ROC) curve was used to determine the cut-off value of plasma sTWEAK in CHF patients. According to the cut-off value, CHF patients were divided into low level group and high level group. After1 year of follow-up, Kaplan-Meier survival curves were used to analyze the time differences between major adverse cardiovascular events(MACE) in the two subgroups, including all-cause death, acute heart failure, acute myocardial infarction, and unstable angina. Results On the next day of admission, the baseline level of plasma sTWEAK in patients with CHF was significantly lower than that in the control group(P<0.05). According to Spearman correlation analysis, plasma sTWEAK was positively correlated with N-terminal brain natriuretic peptide(NT-proBNP) in patients with CHF(r=0.479, P<0.05). The area under the ROC curve was 0.670, and the cut-off value of plasma s TWEAK for the diagnosis of CHF was 192.74 pg/ml(P=0.021). Seventy-two patients were in the sTWEAK high-level group(>192.74 pg/ml), 89 patients in the low-level group(≤192.74 pg/ml), and the mean follow-up(10.78±2.45)months. The incidence of MACE was significantly higher in the sTWEAK high-level group than in the low-level group(P<0.05). According to Kaplan-Meier survival curve analysis, the risk of MACE in the sTWEAK high-level group was significantly higher than that in the low-level group(P<0.05). Conclusion The level of sTWEAK in peripheral blood of patients with chronic heart failure is lower than that of healthy subjects, and it has certain predictive value for the risk of major adverse events in patients with chronic heart failure in the short term.
引文
[1]Sweitzer NK,Airhart S. New therapeutic target in heart failure:achieving and maintaining normokalemia[J]. Circulation,2018,137(13):1331-3.
[2]邱伯雍,王永霞.慢性心力衰竭流行病学及防治研究进展[J].中华实用诊断与治疗杂志,2017,31(6):619-21.
[3]Keshtkar-Jahromi M,Ouyang M,Keshtkarjahromi M,et al. Effect of influenza vaccine on tumor necrosis factor-like weak inducer of apoptosis(TWEAK)in older adults[J]. Vaccine,2018,36(16):2220-5.
[4]赵雪峰,魏秀华.血浆BNP、TNF-α、sTWEAK水平变化与心力衰竭的相关性分析[J].中国实验诊断学,2018,22(5):787-90.
[5]张杰,何飞,郭荣,等.血清可溶性肿瘤坏死因子样弱凋亡诱导因子水平与扩张型心肌病患者左心室重构的关系[J].山东医药,2017,57(17):7-9.
[6]Ponikowski P,Voors AA,Anker SD,et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:TheTask Force for the diagnosis and treatment of acute and chronic heart failure of the EuropeanSociety of Cardiology(ESC). Developed with the special contribution of the Heart FailureAssociation(HFA)of the ESC[J]. Eur J Heart Fail,2016,18(8):891-975.
[7]Qureshi AM,Bansal N,McElhinney DB,et al. Branch pulmonary artery valve implantation reduces pulmonary regurgitation and improves right ventricular size/function in patients with large right ventricular outflow tracts[J]. JACC Cardiovasc Interv,2018,11(6):541-50.
[8]杨鹏会,赵金梅,汪文月.老年性慢性心力衰竭反复发作的危险因素以及预防措施[J].中国循证心血管医学杂志,2016,8(4):458-60.
[9]丁旭,林海龙,李雅洁,等.老年慢性心力衰竭患者临床特点分析[J].中国循证心血管医学杂志,2014,6(4):215-7.
[10]柴坷,王华,杨杰孚.射血分数保留性心力衰竭的病理生理机制和治疗进展[J].中国循环杂志,2016,31(9):921-3.
[11]Chicheportiche Y,Bourdon PR,Xu H,et al. TWEAK,a new secreted ligand in the tumor necrosis factor family that weakly induces apoptosis[J]. J Biol Chem,1997,272(51):32401-10.
[12]Wiley SR,Winkles JA. TWEAK,a member of the TNF superfamily,is a multifunctional cytokine that binds the TweakR/Fn14 receptor[J].Cytokine Growth Factor Rev,2003,14(3-4):241-9.
[13]Yang B,Yan P,Gong H,et al. TWEAK protects cardiomyocyte against apoptosis in a PI3K/AKT pathway dependent manner[J]. Am J Transl Res,2016,8(9):3848-60.
[14]Filusch A,Zelniker T,Baumgartner C,et al. Soluble TWEAK predicts hemodynamic impairment and functional capacity in patients with pulmonary arterial hypertension[J]. Clin Res Cardiol,2011,100(10):879-85.
[15]洪长江,李全亮,张园.TWEAK及其受体在心血管疾病中的作用研究进展[J].军事医学,2016,38(2):158-61.
[2]邱伯雍,王永霞.慢性心力衰竭流行病学及防治研究进展[J].中华实用诊断与治疗杂志,2017,31(6):619-21.
[3]Keshtkar-Jahromi M,Ouyang M,Keshtkarjahromi M,et al. Effect of influenza vaccine on tumor necrosis factor-like weak inducer of apoptosis(TWEAK)in older adults[J]. Vaccine,2018,36(16):2220-5.
[4]赵雪峰,魏秀华.血浆BNP、TNF-α、sTWEAK水平变化与心力衰竭的相关性分析[J].中国实验诊断学,2018,22(5):787-90.
[5]张杰,何飞,郭荣,等.血清可溶性肿瘤坏死因子样弱凋亡诱导因子水平与扩张型心肌病患者左心室重构的关系[J].山东医药,2017,57(17):7-9.
[6]Ponikowski P,Voors AA,Anker SD,et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure:TheTask Force for the diagnosis and treatment of acute and chronic heart failure of the EuropeanSociety of Cardiology(ESC). Developed with the special contribution of the Heart FailureAssociation(HFA)of the ESC[J]. Eur J Heart Fail,2016,18(8):891-975.
[7]Qureshi AM,Bansal N,McElhinney DB,et al. Branch pulmonary artery valve implantation reduces pulmonary regurgitation and improves right ventricular size/function in patients with large right ventricular outflow tracts[J]. JACC Cardiovasc Interv,2018,11(6):541-50.
[8]杨鹏会,赵金梅,汪文月.老年性慢性心力衰竭反复发作的危险因素以及预防措施[J].中国循证心血管医学杂志,2016,8(4):458-60.
[9]丁旭,林海龙,李雅洁,等.老年慢性心力衰竭患者临床特点分析[J].中国循证心血管医学杂志,2014,6(4):215-7.
[10]柴坷,王华,杨杰孚.射血分数保留性心力衰竭的病理生理机制和治疗进展[J].中国循环杂志,2016,31(9):921-3.
[11]Chicheportiche Y,Bourdon PR,Xu H,et al. TWEAK,a new secreted ligand in the tumor necrosis factor family that weakly induces apoptosis[J]. J Biol Chem,1997,272(51):32401-10.
[12]Wiley SR,Winkles JA. TWEAK,a member of the TNF superfamily,is a multifunctional cytokine that binds the TweakR/Fn14 receptor[J].Cytokine Growth Factor Rev,2003,14(3-4):241-9.
[13]Yang B,Yan P,Gong H,et al. TWEAK protects cardiomyocyte against apoptosis in a PI3K/AKT pathway dependent manner[J]. Am J Transl Res,2016,8(9):3848-60.
[14]Filusch A,Zelniker T,Baumgartner C,et al. Soluble TWEAK predicts hemodynamic impairment and functional capacity in patients with pulmonary arterial hypertension[J]. Clin Res Cardiol,2011,100(10):879-85.
[15]洪长江,李全亮,张园.TWEAK及其受体在心血管疾病中的作用研究进展[J].军事医学,2016,38(2):158-61.