摘要
目的 探讨红细胞分布宽度(RDW)、脑钠肽、缺氧诱导因子1α(HIF-1α)及AHEAD评分与慢性心力衰竭(CHF)患者心功能分级、远期死亡结局的关系.方法 采用前瞻性研究方法,选取2016年1月至2019年1月在海南医学院第一附属医院治疗的CHF患者114例作为观察组,选取同期心功能正常人群100例作为对照组.比较两组RDW、脑钠肽、HIF-1α和血脂水平差异.观察组按照美国纽约心脏病学会(NYHA)分级:Ⅱ级32例,Ⅲ级53例,Ⅳ级29例;随访22～49个月,按照死亡事件发生情况分为死亡患者19例,存活患者95例.同时分析观察组心功能不同NY-HA分级、存活和死亡患者RDW、脑钠肽、HIF-1α及AHEAD评分差异.采用受试者工作特征(ROC)曲线分析RDW、脑钠肽、HIF-1α及AHEAD评分预测CHF患者死亡的价值.结果 观察组RDW、脑钠肽和HIF-1α分别为(15.69± 1.88)％、544.54(310.54,840.65)ng/L 和 17.32(9.89,26.65)ng/L,均明显高于对照组,差异均有统计学意义(P＜0.05).随着患者心功能分级升高,患者RDW、脑钠肽、HIF-1α水平以及AHEAD评分≥3分比例升高,差异均有统计学意义(P＜0.05),其中心功能分级Ⅳ级患者RDW、脑钠肽、HIF-1α水平以及AHEAD评分≥3分比例分别为(18.12±2.11)％、712.24(589.30,920.22)ng/L、22.54(17.30,30.21)ng/L 和93.10％,均明显高于心功能分级Ⅱ 级和Ⅲ级患者,差异均有统计学意义(P＜0.05).死亡患者RDW、脑钠肽、HIF-1α水平以及AHEAD评分≥3分比例分别为(17.11±1.92)％、756.03(603.34,1 002.22)g/L、24.40(18.82,33.40)ng/L 和 89.47％,明显高于存活患者,差异均有统计学意义(P＜0.05).RDW、脑钠肽、HIF-1α及AHEAD评分预测死亡的ROC曲线下面积分别为0.672、0.929、0.894和0.679,P＜0.05.结论 随CHF患者心功能分级升高,RDW、脑钠肽、HIF-1α及AHEAD评分水平明显升高,同时在死亡患者中水平较高,其中脑钠肽和HIF-1α在预测远期死亡方面有一定应用价值.
Abstract
Objective To explore the relationship between red blood cell distribution width(RDW),brain natriuretic peptide,hypoxia inducible factor 1 α(HIF-1α)and AHEAD score and cardiac function grading and long-term death outcome in patients with chronic heart fail-ure.Methods Prospective research methods was used,114 patients with chronic heart failure who were treated in the First Affiliated Hospital of Hainan Medical College from January 2016 to January 2019 were selected as the observation group,and 100 patients with normal cardiac function in the same period were selected as the control group.The differences of RDW,brain natriuretic peptide,HIF-1α and blood lipid levels between the two groups were compared.The observation group was classified according to the New York Heart Association(NYHA)classification:32 cases were classified as grade Ⅱ,53 cases as grade Ⅲ,and 29 cases as grade Ⅳ.Follow up for 22-49 months,19 patients were classified as dead and 95 patients were alive based on the occurrence of death events.At the same time,the differences of RDW,brain natriuretic peptide,HIF-1 α and AHEAD scores of patients with different NYHA cardiac function grades,survival and death in the observation group were analyzed.The value of predicting mortality in CHF patients using RDW,brain natriuretic peptide,HIF-1α,and AHEAD scores was analyzed using receiver operating characteristic(ROC)curves.Results The RDW,brain natriuretic peptide and HIF-1α in the observation group were(15.69±1.88)％,544.54(310.54,840.65)ng/L and 17.32(9.89,26.65)ng/L,respectively,which were significantly higher than those in the control group,the differences were statistically significant(P＜0.05).The levels of RDW,brain natriuretic peptide,HIF-1 α and AHEAD score ≥ 3 in-creased with the increase of cardiac function grade,the differences were statistically significant(P＜0.05),the levels of RDW,brain natriuretic peptide,HIF-1α and AHEAD score≥3 in patients with central function grade Ⅳ were(18.12±2.11)％,712.24(589.30,920.22)ng/L,22.54(17.30,30.21)ng/L and 93.10％,respectively,which were significantly higher than those in patients with cardiac function grade Ⅱ andⅢ(P＜0.05).The levels of RDW,brain natriuretic peptide,HIF-1 α and AHEAD score ≥ 3 in dead patients were(17.11±1.92)％,756.03(603.34,1002.22)g/L,24.40(18.82,33.40)ng/L and 89.47％,respectively,which were significantly higher than those in survivors,the differences were statistically significant(P＜0.05).The area under the ROC curve predicted by RDW,brain natriuretic peptide,HIF-1αand AHEAD scores were 0.672,0.929,0.894 and 0.679,respectively,P＜0.05.Conclusion With the increase of cardiac function grade in patients with chronic heart failure,the scores of RDW,brain natriuretic peptide,HIF-1 α and AHEAD increase significantly,and the level are higher in patients with death.Brain natriuretic peptide and HIF-1α have certain application value in predicting long-term death.
NETL
NSTL
维普
万方数据