摘要
目的 探讨膜联蛋白A1、硫氧还蛋白1(Trx-1)及前白蛋白(PAB)对急性心力衰竭(AHF)患者的检测意义及对短期预后的预测价值.方法 回顾性选取2020年1月至2021年12月新疆生产建设兵团医院收治的120例AHF患者作为观察组,另选取同期来本院体检的120名健康志愿者作为对照组.检测两组受检者膜联蛋白A1、Trx-1、PAB表达水平,并建立受试者操作特征(ROC)曲线分析膜联蛋白A1、Trx-1、PAB对AHF的诊断价值.对比不同心功能分级AHF患者膜联蛋白A1、Trx-1、PAB表达水平;应用Spearman相关分析法分析膜联蛋白A1、Trx-1、PAB与AHF严重程度的相关性.随后对所有患者出院后进行90 d随访,将90 d内由于AHF发作再入院或死亡的40例患者分为预后不良组,其余80例患者分为预后良好组,采用多因素Logistics回归模型分析影响AHF患者预后的因素.结果 观察组的膜联蛋白A1、Trx-1水平分别为(2.26±0.39)μg/L、(9.93+2.64)ng/mL,均明显高于对照组[(1.23±0.28)μg/L、(5.64±1.14)ng/mL],观察组 PAB 为(158.78±35.11)mg/L,明显低于对照组[(312.64±43.67)mg/L],差异均有统计学意义(P＜0.05).膜联蛋白A1、Trx-1、PAB联合检测对AHF的诊断敏感度为92.68％、特异度为83.79％,曲线下面积值为0.887,高于单一指标诊断.不同Killip心功能分级患者膜联蛋白A1、Trx-1、PAB表达水平差异显著,Ⅳ级患者膜联蛋白A1、Trx-1水平分别为(2.83±0.33)µg/L、(12.57±2.16)ng/mL,明显高于Ⅲ级、Ⅱ级、Ⅰ级,Ⅳ级患者PAB为(131.25±31.79)mg/L,明显低于Ⅲ级、Ⅱ级、Ⅰ级患者,差异均有统计学意义(P＜0.05).Spearman分析显示:膜联蛋白A1、Trx-1与AHF严重程度呈正相关(r=0.586,0.579,P＜0.05),而PAB与AHF严重程度呈负相关(r=-0.685,P＜0.05).预后良好组与预后不良组患者年龄、陈旧性心肌梗死、膜联蛋白A1、Trx-1、PAB水平比较,差异均有统计学意义(P＜0.05).多因素Logistics回归模型结果显示,年龄、陈旧性心肌梗死、膜联蛋白A1、Trx-1、PAB为影响AHF短期预后的独立危险因素(P＜0.05).结论 AHF患者膜联蛋白A1、Trx-1呈现高表达,PAB呈现低表达状态,通过检测膜联蛋白A1、Trx-1、PAB可为AHF的诊断及严重程度判断提供参考,同时可用于患者短期预后预测.
Abstract
Objective To explore the significance of detecting annexin A1,thioredoxin 1(Trx-1),and prealbumin(PAB)in patients with acute heart failure(AHF)and their predictive value for short-term prognosis.Methods A total of 120 patients with AHF admitted to Xin-jiang Production and Construction Corps Hospital from January 2020 to December 2021 were retrospectively selected as the observation group,and 120 healthy volunteers who underwent physical examination in our hospital during the same period were selected as the control group.The expres-sion levels of annexin A1,Trx-1,and PAB were measured in both groups,and the diagnostic value of annexin A1,Trx-1 and PAB for AHF was analyzed by establishing the receiver operating characteristic(ROC)curve.The expression levels of annexin A1,Trx-1,and PAB in AHF patients with different cordiac function were compared.The correlation between annexin A1,Trx-1,PAB and the severity of AHF was analyzed by Spearman correlation analysis.Subsequently,all patients were followed up for 90 days after discharge,40 patients who were readmitted or died due to AHF attacks within 90 days were divided into the poor prognosis group,while the remaining 80 patients were divided into the good prognosis group.The prognostic factors of AHF patients were analyzed using multivariate Logistic regression models.Results The levels of annexin A1 and Trx-1 in the observation group were(2.26±0.39)μg/L and(9.93±2.64)ng/mL,respectively,which were significantly higher than those in the control group[(1.23±0.28)μg/L,(5.64±1.14)ng/mL],the PAB in the observation group was(158.78±35.11)mg/L,which was significantly lower than that in the control group[(312.64±43.67)mg/L],and the differences were statistically significant(P＜0.05).The diagnostic and specificity of annexin A1,Trx-1,and PAB combined detection for AHF were 92.68％,83.79％,and the area under the curve value was 0.887,which was higher than that of a single indicator diagnosis.There were statistically significant differences in the expression levels of annexin A1,Trx-1,and PAB among patients with different Killip cardiac function grades,with annexin A1 and Trx-1 in the Ⅳ grade pa-tients were(2.83±0.33)μg/L,(12.57±2.16)ng/mL,respectively,which were higher than other grades,the PAB of grade Ⅳ patients was(131.25±31.79)mg/L,which was lower than other grades,and the differences were statistically significant(P＜0.05).Spearman analysis showed that annexin A1 and Trx-1 were positively correlated with the severity of acute heart failure(r=0.586,0.579,P＜0.05),while PAB was negatively correlated(r=-0.685,P＜0.05).There were statistically significant differences in age,old myocardial infarction,annexin A1,Trx-1,and PAB levels between the good prognosis group and the poor prognosis group(P＜0.05).Multivariate Logistic regression model was included.The results showed that age,old myocardial infarction,annexin A1,Trx-1,and PAB were independent risk factors affecting the short-term prognosis of acute heart failure(P＜0.05).Conclusion Annexin A1 and Trx-1 are highly expressed and PAB is low in AHF pa-tients.Detection of annexin A1,Trx-1,and PAB can provide reference for the diagnosis and severity assessment of AHF,and can also be used for short-term prognosis prediction of patients.
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