血清糖类抗原125及脑钠肽水平对心肌梗死后心力衰竭发生及严重程度的预测价值
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摘要
目的探讨血清糖类抗原125(CA125)及脑钠肽(BNP)对急性心肌梗死(AMI)患者住院期间发生心力衰竭(HF)的临床意义及预测价值。方法选取2017年1月至12月郑州人民医院心血管内科收治的AMI患者。完善血清CA125、BNP及心脏彩色超声等检查。冠状动脉灌注治疗后1周内评估患者心功能。分析血清CA125、BNP水平及心脏彩色超声各指标间的相关性。对比HF患者不同NYHA心功能分级分组间CA125、BNP、左心室射血分数(LVEF)水平。结果共有124例AMI患者入组,其中41例(33.1%)患者出现符合诊断标准的HF。血清CA125、BNP水平与LVEF呈负相关(r=-0.227,P=0.011; r=-0.569,P<0.001),CA125与BNP呈正相关(r=0.270,P=0.002)。ROC曲线显示,CA125预测AMI后HF发生的AUC为0.772(95%CI 0.679～0.864,P<0.01),BNP的AUC为0.938(95%CI 0.888～0.988,P<0.01)。41例AMI后HF患者不同NYHA分级组之间,随着NYHA分级的升高,血清CA125、BNP水平随之升高,LVEF随之下降,且组间CA125、BNP、LVEF差异均有统计学意义(P<0.001)。结论血清CA125、BNP水平对AMI后HF的发生有预测价值,并与HF的临床严重程度相关。
Aim To investigate the clinical significance and predictive value of serum carbohydrate antigen 125(CA125) and brain natriuretic peptide(BNP) in patients with acute myocardial infarction(AMI) and heart failure(HF)occurred during hospitalization.Methods AMI patients admitted to cardiovascular department of Zhengzhou People's Hospital were selected from January to December in 2017.Serum CA125,BNP and color Doppler echocardiography were examined.Cardiac function was assessed within 1 week after coronary artery infusion therapy.The correlation among serum CA125,BNP levels and the indexes of color echocardiography were analyzed.The levels of CA125,BNP and left ventricular ejection fraction(LVEF) in different NYHA cardiac function classification groups of HF patients were compared.Results A total of 124 AMI patients was enrolled,of whom 41(33.1%) had met the diagnostic criteria for HF.Serum CA125 and BNP levels were negatively correlated with LVEF(r=-0.227,P=0.011;r=-0.569,P<0.001),and CA125 was positively correlated with BNP(r=0.270,P=0.002).The area under curve(AUC) of CA125 predicting HF occurrence after AMI was 0.772(95%CI 0.679-0.864,P<0.01),and AUC of BNP was 0.938(95% CI 0.888-0.988,P<0.01).Among different NYHA classification groups in 41 patients with HF after AMI,with the increase of NYHA classification,serum levels of CA125 and BNP increased,and LVEF decreased.The differences of CA125,BNP and LVEF among groups were statistically significant(P<0.001).Conclusion Serum levels of CA125 and BNP have predictive value for the occurrence of HF after AMI,and are correlated with the clinical severity of HF.
Aim To investigate the clinical significance and predictive value of serum carbohydrate antigen 125(CA125) and brain natriuretic peptide(BNP) in patients with acute myocardial infarction(AMI) and heart failure(HF)occurred during hospitalization.Methods AMI patients admitted to cardiovascular department of Zhengzhou People's Hospital were selected from January to December in 2017.Serum CA125,BNP and color Doppler echocardiography were examined.Cardiac function was assessed within 1 week after coronary artery infusion therapy.The correlation among serum CA125,BNP levels and the indexes of color echocardiography were analyzed.The levels of CA125,BNP and left ventricular ejection fraction(LVEF) in different NYHA cardiac function classification groups of HF patients were compared.Results A total of 124 AMI patients was enrolled,of whom 41(33.1%) had met the diagnostic criteria for HF.Serum CA125 and BNP levels were negatively correlated with LVEF(r=-0.227,P=0.011;r=-0.569,P<0.001),and CA125 was positively correlated with BNP(r=0.270,P=0.002).The area under curve(AUC) of CA125 predicting HF occurrence after AMI was 0.772(95%CI 0.679-0.864,P<0.01),and AUC of BNP was 0.938(95% CI 0.888-0.988,P<0.01).Among different NYHA classification groups in 41 patients with HF after AMI,with the increase of NYHA classification,serum levels of CA125 and BNP increased,and LVEF decreased.The differences of CA125,BNP and LVEF among groups were statistically significant(P<0.001).Conclusion Serum levels of CA125 and BNP have predictive value for the occurrence of HF after AMI,and are correlated with the clinical severity of HF.
引文
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[13]高亚松,丁超.急性ST段抬高型心肌梗死患者发生自发再灌注的预测因素及预后分析[J].中国循证心血管医学杂志,2018,10(1):68-75.
[14]Huang F,Chen J,Liu Y,et al.New mechanism of elevated CA125 in heart failure:The mechanical stress and inflammatory stimuli initiate CA125 synthesis[J].Med Hypotheses,2012,79(3):381-383.
[15]Yalta K,Yilmaz A,Turgut OO,et al.Evaluation of tumor markers CA125 and CEA in acute myocardial infarction[J].Adv Ther,2006,23(6):1052-1059.
[16]Napan S,Aussawapokee T,Nargileci E,et al.Prognostic significance of carbohydrate antigen 125 in patients with heart failure and preserved ejection fraction(abstract)[J].J Am Coll Cardiol,2010,55(1):30-35.
[17]Nieminen MS,Bohm M,Cowie MR,et al.Executive summary of the guidelines on the diagnosis and treatment of acute heart failure:the Task Force on Acute Heart Failure of the European Society of Cardiology[J].Eur Heart J,2005,26(4):384-416.
[18]Nagele H,Bahlo M,Klapdor R,et al.CA 125 and its relation to cardiac function[J].Am Heart J,1999,137(6):1044-1049.
[19]D'Aloia A,Faggiano P,Aurigemma G,et al.Serum levels of carbohydrate antigen 125 in patients with chronic heart failure:relation to clinical severity,hemodynamic and Doppler echocardiographic abnormalities,and shortterm prognosis[J].J Am Coll Cardiol,2003,41(10):1805-1811.
[20]Kouris NT,Zacharos ID,Kontogianni DD,et al.The significance of CA125 levels in patients with chronic congestive heart failure:Correlation with clinical and echocardiographic parameters[J].Eur J Heart Fail,2005,7(2):199-203.
[21]De Gennaro L,Brunetti ND,Bungaro R,et al.Carbohydrate antigen-125:additional accuracy in identifying patients at risk of acute heart failure in acute coronary syndrome[J].Coron Artery Dis,2009,20(4):274-280.
[22]Mansour IN,Napan S,Tarek Alahdab M,et al.Carbohydrate antigen 125 predicts long-term mortality in African American patients with acute decompensated heart failure[J].Congest Heart Fail,2010,16(1):15-20.
[23]Yilmaz MB,Zorlu A,Dogan OT,et al.Role of CA-125 in identification of right ventricular failure in chronic obstructive pulmonary disease[J].Clin Cardiol,2011,34(4):244-248.
[24]Zhuang J,Faggiano P,Li Q,et al.Insights into the clinical implications of carbohydrate antigen 125 as a biomarker of heart failure:a meta-analysis and systematic review of published studies[J].J Cardiovasc Med,2014,15(12):864-872.
[2]Falcao F,de Oliveira FRA,da Silva MCFC,et al.Carbohydrate antigen 125:a promising tool for risk stratification in heart diseases[J].Biomark Med,2018,12(4):367-381.
[3]Li X,He M,Zhu J,et al.Higher carbohydrate antigen 125levels are associated with increased risk of coronary heart disease in elderly Chinese:a population-based case-control study[J].PLoS One,2013,8(11):e81328.
[4]Kaya H,Zorlu A,Yucel H,et al.Cancer antigen-125levels predict long-term mortality in chronic obstructive pulmonary disease[J].Biomarkers,2015,20(2):162-167.
[5]Ponikowski P,Voors AA,Anker SD,et al.2016 ESCGuidelines for the diagnosis and treatment of acute and chronic heart failure[J].Eur Heart J,2016,37(27):2129-2200.
[6]Vizzardi E,D'Aloia A,Curnis A,et al.Carbohydrate antigen 125:a new biomarker in heart failure[J].Cardiol Rev,2013,21(1):23-26.
[7]Avitall B,Bi J,Mykytsey A,et al.Atrial and ventricular fibrosis induced by atrial fibrillation:evidence to support early rhythm control[J].Heart Rhythm,2008,5(6):839-845.
[8]Yucel H,Kaya H,Zorlu A,et al.Cancer antigen 125levels and increased risk of newonset atrial fibrillation[J].Herz,2015,20(2):119-124.
[9]De Gennaro L,Brunetti ND,Montrone D,et al.Inflammatory activation and carbohydrate antigen-125 levels in subjects with atrial fibrillation[J].Eur J Clin Invest,2012,42(4):371-375.
[10]Yilmaz MB,Zorlu A,Tandogan I,et al.Plasma CA-125level is related to both sides of the heart:a retrospective analysis[J].Int J Cardiol,2011,149(1):80-82.
[11]Kaya H,Kurt R,Beton O,et al.Cancer antigen 125 is associated with length of stay in patients with acute heart failure[J].Tex Heart Inst J,2017,44(1):22-28.
[12]李睿,栾波,段娜,等.辽西不同地区急性心肌梗死相关危险因素比较分析[J].中国循证心血管医学杂志,2018,10(3):300-303.
[13]高亚松,丁超.急性ST段抬高型心肌梗死患者发生自发再灌注的预测因素及预后分析[J].中国循证心血管医学杂志,2018,10(1):68-75.
[14]Huang F,Chen J,Liu Y,et al.New mechanism of elevated CA125 in heart failure:The mechanical stress and inflammatory stimuli initiate CA125 synthesis[J].Med Hypotheses,2012,79(3):381-383.
[15]Yalta K,Yilmaz A,Turgut OO,et al.Evaluation of tumor markers CA125 and CEA in acute myocardial infarction[J].Adv Ther,2006,23(6):1052-1059.
[16]Napan S,Aussawapokee T,Nargileci E,et al.Prognostic significance of carbohydrate antigen 125 in patients with heart failure and preserved ejection fraction(abstract)[J].J Am Coll Cardiol,2010,55(1):30-35.
[17]Nieminen MS,Bohm M,Cowie MR,et al.Executive summary of the guidelines on the diagnosis and treatment of acute heart failure:the Task Force on Acute Heart Failure of the European Society of Cardiology[J].Eur Heart J,2005,26(4):384-416.
[18]Nagele H,Bahlo M,Klapdor R,et al.CA 125 and its relation to cardiac function[J].Am Heart J,1999,137(6):1044-1049.
[19]D'Aloia A,Faggiano P,Aurigemma G,et al.Serum levels of carbohydrate antigen 125 in patients with chronic heart failure:relation to clinical severity,hemodynamic and Doppler echocardiographic abnormalities,and shortterm prognosis[J].J Am Coll Cardiol,2003,41(10):1805-1811.
[20]Kouris NT,Zacharos ID,Kontogianni DD,et al.The significance of CA125 levels in patients with chronic congestive heart failure:Correlation with clinical and echocardiographic parameters[J].Eur J Heart Fail,2005,7(2):199-203.
[21]De Gennaro L,Brunetti ND,Bungaro R,et al.Carbohydrate antigen-125:additional accuracy in identifying patients at risk of acute heart failure in acute coronary syndrome[J].Coron Artery Dis,2009,20(4):274-280.
[22]Mansour IN,Napan S,Tarek Alahdab M,et al.Carbohydrate antigen 125 predicts long-term mortality in African American patients with acute decompensated heart failure[J].Congest Heart Fail,2010,16(1):15-20.
[23]Yilmaz MB,Zorlu A,Dogan OT,et al.Role of CA-125 in identification of right ventricular failure in chronic obstructive pulmonary disease[J].Clin Cardiol,2011,34(4):244-248.
[24]Zhuang J,Faggiano P,Li Q,et al.Insights into the clinical implications of carbohydrate antigen 125 as a biomarker of heart failure:a meta-analysis and systematic review of published studies[J].J Cardiovasc Med,2014,15(12):864-872.