【作者】 王文婷；

【导师】 任宏生；

【作者基本信息】 山东大学 ， 内科学（心血管病）（专业学位）， 2021， 硕士

【摘要】 目的分析NT-proBNP、H-FABP和OPG对慢性心力衰竭患者心功能严重程度及对不同类型心力衰竭患者临床诊断及预后评估价值。方法本研究选取2020年6月—2020年10月在山东大学附属山东省立医院东院心内科住院治疗的慢性心力衰竭患者98例。收集患者一般临床资料,应用酶联免疫吸附试验(ELISA)检测外周血清中H-FABP及OPG水平,根据左心室射血分数(LVEF)分为 HFrEF(N=39)、HFmrEF(N=11)和 HFpEF(N=48)3 组,对比三组慢性心衰患者一般临床资料和H-FABP及OPG水平,分析H-FABP及OPG与慢性心力衰竭不同临床类型、不同心衰严重程度及超声心动图相关测量指标的相关性,评价NT-proBNP、H-FABP、OPG单独检测及联合检测对HFrEF及HFpEF的诊断价值。所有患者出院后随访3-6个月,根据随访半年后发生终点事件(心血管死亡或心力衰竭再次入院)结局,评估NT-proBNP、H-FABP、OPG对慢性心衰患者临床预后的预测价值。结果1.慢性心力衰竭患者外周血NT-proBNP、H-FABP、OPG水平在HFrEF、HFmrEF、HFpEF三组中分布不同,差异具有统计学意义(P<0.05);2.H-FABP 与 NYHA 分级(r=0.61)、LA(r=0.46)、LV(r=0.51)、HS-TnT(r=0.31)、NT-proBNP(r=0.58)、SUA(r=0.38)等呈正相关,与 LVEF 呈负相关(r=-0.76);OPG 与NYHA 心功能分级(r=0.60)、LA(r=0.36)、LV(r=0.32)、NT-proBNP(r=0.49)等呈正相关,与 LVEF(r=-0.60)呈负相关,(P<0.05);3.对慢性心力衰竭患者不同心功能程度(NYHA分级)进行多因素回归分析显示,与NYHAⅡ级相比,H-FABP水平升高的患表现为NYHAⅢ级的风险增加2.13倍(OR=2.13(1.099,4.112),P<0.05),表现为 NYHA Ⅳ级的风险增加 2.95 倍(OR=2.95(1.429,6.072),P<0.05)。然而 OPG 与 NT-proBNP 水平对慢性心衰患者表现为NYHA Ⅱ级、NYHA Ⅲ级、NYHA Ⅳ级的风险的影响均未见明显差异(P>0.05);4.对不同类型心力衰竭患者进行多因素回归分析显示,以HFpEF组为对照,血清中H-FABP升高是HFrEF及HFmrEF的独立危险因素,慢性心力衰竭患者外周血中 H-FABP 水平越高,表现为 HFrEF(OR=2.37(1.596,3.529),P<0.001)和HFmrEF(OR=1.47(1.055,2.040),P<0.05)的风险越高;而 OPG 与 NT-proBNP 水平对HFrEF、HFmrEF、HFpEF等慢性心力衰竭患者之间无显著差异(P>0.05);5.对NT-proBNP、H-FABP、OPG及终点事件进行二元Logistic回归分析显示,NT-proBNP在预测慢性心力衰竭患者死亡及再入院等终点事件具有较高的价值,慢性心力衰竭患者再入院率&死亡率随NT-proBNP浓度增高而增高(P<0.05)。而H-FABP和OPG对慢性心力衰竭患者预后的评估无明显作用(P>0.05)。6.血清NT-proBNP、H-FABP和OPG对HFrEF均有较高的诊断价值。与传统生物标志物NT-proBNP相比,H-FABP诊断HFrEF敏感度(94.9%)及特异度(83.1%)均较高,而OPG诊断HFrEF的敏感度(92.3%)较高,特异度(57.7%)较差。联合检测NT-proBNP、H-FABP和OPG可显著提高对HFrEF患者的诊断的敏感度(86.44%)及特异度(89.74%)。7.血清NT-proBNP、H-FABP和OPG对HFpEF均有较高的诊断价值。与传统生物标志物NT-proBNP相比,H-FABP诊断HFpEF敏感度(91.7%)及特异度(82.0)较高,而OPG诊断HFpEF的特异度(82.0%)较高,敏感度(58.3%)较差。联合检测NT-proBNP、H-FABP及OPG可提高对HFpEF诊断的敏感度(91.7%)及特异度(78%),可作为早期评估慢性心力衰竭患者心功能下降的重要生物标记物。结论1.血清H-FABP和OPG与慢性心力衰竭患者LVEF呈负相关,与NYHA分级呈正相关,可反映心功能不全严重程度;2.H-FABP作为新型生物标志物对慢性心衰患者不同临床类型的诊断具有一定的价值,是慢性心衰患者出现HFpEF及HFrEF的独立预测因素;3.NT-proBNP是慢性心衰患者出现终点事件的独立危险因素,可作为慢性心力衰竭患者预后评估的重要生物标志物;而H-FABP及OPG则对慢性心衰患者预后无明显评估价值;4.检测慢性心衰患者外周血中H-FABP、OPG可提高对HFrEF及HFpEF诊断的敏感度及特异度,联合检测H-FABP、OPG及NT-proBNP可作为早期评估慢性心力衰竭患者心功能下降的重要策略。更多还原

【Abstract】 ObjectiveTo analyze the value of NT-proBNP,H-FABP and OPG in the severity of cardiac function and in clinical diagnosis and prognosis of patients with different types of heart failure.MethodsNinety-eight patients with chronic heart failure were selected from June 2020 to October 2020 in the Department of Cardiology,East Hospital,Shandong Provincial Hospital affiliated to Shandong University.The general clinical data of patients were collected,and the levels of H-FABP and OPG in peripheral blood were detected by enzyme linked immunosorbent assay(ELISA).According to the left ventricular ejection fraction(LVEF),the patients were divided into HFrEF(N=39),HFmrEF(N=11)and HFpEF(N=48)groups.The general clinical data and the levels of H-FABP and OPG in the three groups of patients with chronic heart failure were compared to analyze and evaluate the correlation of H-FABP and OPG with different clinical types and the severity of chronic heart failure,as well as echocardiographic indexes.Evaluating the diagnostic value of single and combined detection of NT-proBNP,H-FABP and OPG in patients with HFrEF and HFpEF.All patients were followed up for 3-6 months after discharge.According to the outcome of endpoint events(cardiovascular death or re-admission of heart failure)after half a year of follow-up,the predictive value of NT-proBNP,H-FABP and OPG in clinical prognosis of patients with chronic heart failure was evaluated-Results1.NT-proBNP,H-FABP and OPG were significantly different among the three groups of chronic heart failure(HFrEF,HFmrEF and HFpEF)(P<0.05);2.H-FABP was positively correlated with NYHA grade(r=0.61),LA(r=0.46),LV(r=0.51),HS-TnT(r=0.31),NT-proBNP(r=0.58)and SUA(r=0.38),and negatively correlated with LVEF(r=-0.76).OPG was positively correlated with NYHA grade(r=0.60),LA(r=0.36),LV(r=0.32)and NT-proBNP(r=0.49),and negatively correlated with LVEF(r=-0.60),(P<0.05);3.Multivariate regression analysis of NYHA grade of chronic heart failure showed that compared with NYHA Ⅱ,patients with elevated H-FABP had a 2.13-fold increased risk of developing NYHA Ⅲ(OR=2.13(1.099,4.112,P<0.05),and a 2.95-fold increased risk of developing NYHA Ⅳ(OR=2.95(1.429,6.072),P<0.05).However,there was no significant difference between OPG and NT-proBNP levels on the risk of NYHA Ⅱ,NYHA Ⅲ and NYHA Ⅳ in patients with chronic heart failure(P>0.05).4.Multivariate regression analysis of different groups of CHF showed that H-FABP was an independent risk factor for HFrEF and HFmrEF while the HFpEF as a controller.In patients with chronic heart failure,the higher the level of H-FABP in peripheral blood,the higher the risk of HFrEF(OR=2.37(1.596,3.529),P<0.001)and HFmrEF(OR=1.47(1.055,2.040),P<0.05).However,there was no significant difference between OPG and NT-proBNP levels in HFrEF,HFmrEF and HFpEF(P>0.05).5.Binary Logistic regression analysis of NT-proBNP,H-FABP and OPG showed that NT-proBNP had significant value in predicting the prognosis of patients with chronic heart failure,and the readmission rate and mortality of patients with chronic heart failure increased with the increase of NT-proBNP concentration(P<0.05).However,H-FABP and OPG had no significant effect on the prognosis of patients with chronic heart failure(P>0.05).6.Serum NT-proBNP,H-FABP and OPG have high diagnostic value for HFrEF.Compared with NT-proBNP,H-FABP had a higher sensitivity(94.9%)and specificity(83.1%)in the diagnosis of HFrEF,while OPG had a higher sensitivity(92.3%)and a poorer specificity(57.7%)in the diagnosis of HFrEF.Combined detection of NT-proBNP,H-FABP and OPG can improve the sensitivity(86.44%)and specificity(89.74%)in the diagnosis of HFrEF.7.Serum NT-proBNP,H-FABP and OPG have high diagnostic value for HFpEF.Compared with NT-proBNP,H-FABP had higher sensitivity(91.7%)and specificity(82.0)in the diagnosis of HFpEF,while OPG had higher specificity(82.0%)and poor sensitivity(58.3%)in the diagnosis of HFpEF.The combined detection of NT-proBNP,H-FABP and OPG can improve the sensitivity(91.7%)and specificity(78.0%)in the diagnosis of HFpEF,and H-FABP can be used as an important biomarker for early evaluation of cardiac dysfunction in patients with chronic heart failure.Conclusions1.Serum H-FABP and OPG are negatively correlated with LVEF in patients with chronic heart failure,and positively correlated with NYHA grade,which could reflect the severity of cardiac dysfunction.2.As a new biomarker,H-FABP has a certain value in the diagnosis of different clinical types of patients with CHF,and is an independent predictor of HFpEF and HFrEF in patients with chronic heart failure.3.NT-proBNP is an independent risk factor for end point events in patients with chronic heart failure,and can be used as an important biomarker for prognosis evaluation in patients with chronic heart failure.H-FABP and OPG had no significant prognostic value in patients with chronic heart failure.The detection of H-FABP and OPG can improve the sensitivity and specificity for the diagnosis of HFrEF and HFpEF,and the combined detection of H-FABP,OPG and NT-proBNP can be used as important biomarkers for early evaluation of cardiac dysfunction in patients with chronic heart failure.4.Detection of H-FABP and OPG can improve the sensitivity and specificity of the diagnosis for HFrEF and HFpEF.Combined detection of H-FABP,OPG and NT-proBNP can be used as an important strategy for early evaluation of cardiac function decline in patients with chronic heart failure.更多还原