老年慢性心力衰竭患者血清可溶性尿激酶型纤溶酶原激活物受体水平变化及临床意义
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摘要
目的:探讨可溶性尿激酶型纤溶酶原激活物受体(suPAR)水平对老年慢性心力衰竭(CHF)患者的早期诊断及预后评估的价值。方法:筛选2016-01-2017-08本院收治的105例CHF患者(CHF组),心功能Ⅱ级28例,心功能Ⅲ级55例,心功能Ⅳ级22例。另设同期健康体检且结果为正常者50例为对照组。使用双抗体夹心酶联免疫吸附(Elisa)法检测2组研究对象血清suPAR水平。应用超声心动图测定心功能,并计算平均室壁应力(MWS)和左心室心肌质量指数(LVMI)。比较2组研究对象及不同心功能分级患者的血清suPAR水平及心功能LVMI、MWS水平。CHF老年患者血清suPAR水平经Pearson分析与LVMI、MWS呈明显相关性。出院后第12个月心脏彩超复查患者心功能,统计发生心脏事件的病例数,比较并发心脏事件与无心脏事件发生的患者入院时血清suPAR水平。多因素logistic回归分析血清suPAR水平与CHF患者心脏事件的相关性。结果:与对照组比较,CHF组患者血清suPAR水平及MWS、LVMI增高,且随心功能分级增大而显著增加,差异有统计学意义(P<0.01)。CHF老年患者血清suPAR水平经Pearson分析与MWS和LVMI呈正相关(r=0.609和0.644,P=0.000和0.000)。出院后第12个月发现,随访并发心脏事件的CHF老年患者入院时血清suPAR水平显著高于无心脏事件患者。CHF老年患者血清suPAR水平经多因素Logistic回归分析确定为发生12个月心脏事件的危险因素之一。结论:血清suPAR水平可能是CHF老年患者早期诊断及其预后判断的有效指标之一。
Objective:To investigate the value of serum level of soluble urokinase-type plasminogen activator receptor(suPAR)in early diagnosis and prognosis of elderly patients with chronic heart failure(CHF).Method:One hundred and five elderly patients with CHF(CHF group)were selected in our hospital from Jan of 2016 to Aug of 2018 with cardiac function gradeⅡ 28 cases,cardiac function gradeⅢ 55 cases,and cardiacⅣ 22 cases.Menwhile fifty health elderly people were enrolled as control group subjects(control group).Double antibody sandwich enzyme-linked immunosorbent assay(Elisa)was used to measure serum level of suPAR for two groups.was employed to detect heart function and mean wall stress(MWSs)and left ventricular mass index(LVMI)were counted.Serum level of sTREM-1 and MWSs and LVMI were compared between both groups and among patients with different cardiac functional grades.The correlation between serum level of sTREM-1 and LVMI and MWS was analyzed by pearson linear correlation analysis in elderly patients.Cardiac function was reviewed by color doppler ultrasound at 12 months after discharge,the number of cases of cardiac events were counted,and serum level of suPAR was compared in cases with cardiac events and cases without cardiac events on admission.Relatioship between serum level of suPAR and cardiac events was analyzed by multivariate logistic regression analysis.Result:Serum level of suPAR in CHF patients was significantly higher than that in the control group and significantly with the increase of cardiac function grade.Serum level of suPAR of elderly CHF patients was positively correlated with the MWS and LVMI(r=0.609 and 0.644,P=0.000 and 0.000).Its level was obviously higher in cases with cardiac events than those without cardiac events at followed up for 12 months(P<0.01).Serum level of suPAR in elderly patients with CHF was one of hazards factors of 12 months cardiac events.Conclusion:Serum level of suPAR can be one of effective indexes for the early diagnosis and prognosis in elderly patients with CHF.
Objective:To investigate the value of serum level of soluble urokinase-type plasminogen activator receptor(suPAR)in early diagnosis and prognosis of elderly patients with chronic heart failure(CHF).Method:One hundred and five elderly patients with CHF(CHF group)were selected in our hospital from Jan of 2016 to Aug of 2018 with cardiac function gradeⅡ 28 cases,cardiac function gradeⅢ 55 cases,and cardiacⅣ 22 cases.Menwhile fifty health elderly people were enrolled as control group subjects(control group).Double antibody sandwich enzyme-linked immunosorbent assay(Elisa)was used to measure serum level of suPAR for two groups.was employed to detect heart function and mean wall stress(MWSs)and left ventricular mass index(LVMI)were counted.Serum level of sTREM-1 and MWSs and LVMI were compared between both groups and among patients with different cardiac functional grades.The correlation between serum level of sTREM-1 and LVMI and MWS was analyzed by pearson linear correlation analysis in elderly patients.Cardiac function was reviewed by color doppler ultrasound at 12 months after discharge,the number of cases of cardiac events were counted,and serum level of suPAR was compared in cases with cardiac events and cases without cardiac events on admission.Relatioship between serum level of suPAR and cardiac events was analyzed by multivariate logistic regression analysis.Result:Serum level of suPAR in CHF patients was significantly higher than that in the control group and significantly with the increase of cardiac function grade.Serum level of suPAR of elderly CHF patients was positively correlated with the MWS and LVMI(r=0.609 and 0.644,P=0.000 and 0.000).Its level was obviously higher in cases with cardiac events than those without cardiac events at followed up for 12 months(P<0.01).Serum level of suPAR in elderly patients with CHF was one of hazards factors of 12 months cardiac events.Conclusion:Serum level of suPAR can be one of effective indexes for the early diagnosis and prognosis in elderly patients with CHF.
引文
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[12] 杨玲玲,李树仁,李沙.半乳糖凝集素-3在急慢性心力衰竭患者中的意义[J].临床心血管病杂志,2017,33(4):385-388.
[13] Bradley JM,Spaletra P,Li Z,et al.A novel fibroblast activation inhibitor attenuates left ventricular remodeling and preserves cardiac function in heart failure[J].Am J Physiol Heart Circ Physiol,2018,315(3):H563-H570.
[14] 邬涛,吴清华,吴丹,等.慢性心力衰竭患者外周血NF-κB、血清TGF-β1与心室重构的相关性[J].重庆医学,2016,45(24):3408-3411.
[15] Santos FV,Chiappa GR,Ramalho SHR,et al.Resistance exercise enhances oxygen uptake without worsening cardiac function in patients with systolic heart failure:a systematic review and meta-analysis[J].Heart Fail Rev,2018,23(1):73-89.
[16] 张富,谢许萍,刘细斌,等.三维斑点追踪技术评价冠状动脉粥样硬化性心脏病患者左心室重构的价值[J].中国现代医学杂志,2017,27(11):75-77.
[17] 王彦军,朱琳,俞天虹,等.血浆suPAR水平与冠心病患者冠状动脉斑块稳定性、病变程度及冠心病预测之间的关系[J].中国动脉硬化杂志,2015,23(12):1236-1240. (收稿日期:2018-09-19;修回日期:2018-10-25)
[2] 陈伟伟.中国心血管病报告2015[J].中华医学信息导报,2016,31(12):11.
[3] 董晓瑞,臧兵兵.马来酸依那普利叶酸片治疗老年慢性心力衰竭临床疗效观察[J].重庆医学,2017,46(5):685-687.
[4] Bahrmann P,Hardt R.Chronic heart failure in older patients:Updated national healthcare guidelines on chronic heart failure from a geriatric perspective[J].Z Gerontol Geriatr,2018,51(2):165-168.
[5] Vakili H,Shirazi M,Charkhkar M,et al.Correlation of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio with thrombolysis in myocardial infarction frame count in ST-segment elevation myocardial infarction[J].Eur J Clin Invest,2017,47(4):322-327.
[6] 中华医学会心血管病学分会.中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.
[7] Kasama S,Toyama T,Iwasaki T,et al.Effects of oral nicorandiltherapy on sympathetic nerve activity and cardiac events in patients with chronic heart failure:subanalysis of our previous report using propensity score matching[J].Eur J Nucl Med Mol Imaging,2014,41(1):144-154.
[8] 黄奕君,郑茵,李伟,等.血清TIMP-4水平在老年慢性心力衰竭早期诊断及预后评估中的价值[J].山东医药,2017,57(36):17-20.
[9] 王琴,杨毅宁.冠心病心力衰竭患者平均血小板体积变化及意义[J].山东医药,2016,56(44):55-57.
[10] McMillan R,Skiadopoulos L,Hoppensteadt D,et al.Biomarkers of Endothelial,Renal,and Platelet Dysfunction in Stage 5 Chronic Kidney Disease Hemodialysis Patients With Heart Failure[J].Clin Appl Thromb Hemost,2018,24(2):235-240.
[11] 殷华,马少雯,杜一平.生长分化因子-15对慢性心力衰竭患者左室重构的预测价值[J].中华老年多器官疾病杂志,2017,16(9):659-662.
[12] 杨玲玲,李树仁,李沙.半乳糖凝集素-3在急慢性心力衰竭患者中的意义[J].临床心血管病杂志,2017,33(4):385-388.
[13] Bradley JM,Spaletra P,Li Z,et al.A novel fibroblast activation inhibitor attenuates left ventricular remodeling and preserves cardiac function in heart failure[J].Am J Physiol Heart Circ Physiol,2018,315(3):H563-H570.
[14] 邬涛,吴清华,吴丹,等.慢性心力衰竭患者外周血NF-κB、血清TGF-β1与心室重构的相关性[J].重庆医学,2016,45(24):3408-3411.
[15] Santos FV,Chiappa GR,Ramalho SHR,et al.Resistance exercise enhances oxygen uptake without worsening cardiac function in patients with systolic heart failure:a systematic review and meta-analysis[J].Heart Fail Rev,2018,23(1):73-89.
[16] 张富,谢许萍,刘细斌,等.三维斑点追踪技术评价冠状动脉粥样硬化性心脏病患者左心室重构的价值[J].中国现代医学杂志,2017,27(11):75-77.
[17] 王彦军,朱琳,俞天虹,等.血浆suPAR水平与冠心病患者冠状动脉斑块稳定性、病变程度及冠心病预测之间的关系[J].中国动脉硬化杂志,2015,23(12):1236-1240. (收稿日期:2018-09-19;修回日期:2018-10-25)