摘要
目的 探讨血清可溶性致癌抑制因子2(sST2)、C-X-C基序趋化因子配体16(CXCL16)水平与重症心力衰竭(SHF)患者预后的相关性.方法 回顾性选取2022年1月至2024年1月青海省第四人民医院收治入院的84例SHF患者作为研究对象,随访6个月,参考预后情况将患者分为死亡组(n=20)和存活组(n=64).收集两组患者的临床资料[性别、年龄、病程、体重、收缩压、纽约心脏病协会(NYHA)分级、原发病症、左室射血分数(LVEF)、脑钠肽、血肌酐、血尿酸],并检测患者血清sST2、CXCL16水平.采用多因素Logistic回归分析对影响SHF死亡的影响因素进行分析;采用受试者操作特征(ROC)分析SHF死亡预测中sST2、CXCL16的价值.结果 两组患者性别构成比、年龄、体重、血肌酐、原发病症比较,差异均无统计学意义(P＞0.05);较存活组,死亡组患者的病程更长,NYHA分级Ⅳ级比率更高,收缩压、LVEF均更低,脑钠肽、血尿酸、sST2、CXCL16水平均更高,差异均有统计学意义(P＜0.05).多因素Logistic回归分析结果显示,LVEF、收缩压为SHF患者死亡的独立保护因素(P＜0.05),sST2、CXCL16、脑钠肽、NYHA分级及病程为SHF患者死亡的危险因素(P＜0.05).SHF患者死亡预测中sST2与CXCL16联合检测的曲线下面积(AUC)为0.851,大于sST2或者CXCL16单独检测(0.749、0.766),敏感度、特异度分别为92.67％、68.49％,均高于sST2(78.04％、63.77％)或者 CXCL16 单独检测(85.36％、52.75％),差异均有统计学意义(P＜0.05).结论 sST2、CXCL16水平升高与SHF患者预后密切相关,联合测定血清sST2、CXCL1 6水平预测SHF死亡风险更为精准.
Abstract
Objective To explore the correlation between serum levels of soluble suppression of tumorigenicity 2(sST2),C-X-C motif chemokine ligand 16(CXCL16)and prognosis in patients with severe heart failure(SHF).Methods A total of 84 patients with SHF admitted to The Fourth Peoples Hospital of Qinghai from January 2022 to January 2024 were retrospectively selected as the study subjects and followed up for 6 months.According to the prognosis,they were divided into death group(n=20)and survival group(n=64).Clinical data[Gender,age,course of disease,weight,systolic blood pressure,New York Heart Association(NYHA)class,primary disease,left ventricular ejection fraction(LVEF),brain natriuretic peptide,serum creatinine,serum uric acid]were collected from both groups,and the levels of serum sST2 and CX-CL16 were tested.The influencing factors of SHF death was analyzed using multivariate Logistic regression analysis.The value of sST2 and CX-CL16 in the prediction of SHF death was analyzed by receiver operating characteristic(ROC).Results There were no statistically significant differences in gender composition ratio,age,weight,serum creatinine and primary disease between the two groups(P＞0.05).Compared with the survival group,the course of disease in the death group was longer,the ratio of NYHA grade Ⅳ was higher,the systolic blood pressure and LVEF were lower,and the levels of brain natriuretic peptide,serum uric acid,sST2 and CXCL16 were higher,the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that LVEF and systolic blood pressure were independent protective factors for death in patients with SHF(P＜0.05),and sST2,CXCL16,brain natriuretic peptide,NYHA grade and course of disease were risk factors for death in patients with SHF(P＜0.05).The area under the curve(AUC)of the combined detection of sST2 and CXCL16 in the prediction of death in patients with SHF was 0.851,which was greater than that of sST2 or CXCL16 alone(0.749,0.766),the sensitivity and specificity were 92.67％and 68.49％,respectively,which were higher than those of sST2(78.04％,63.77％)or CXCL16 alone(85.36％,52.75％),and the differences were statistically significant(P＜0.05).Conclusion The increased levels of sST2 and CXCL16 are closely related to the prognosis of patients with SHF,and the combined determination of sST2 and CXCL16 is more accurate in predicting the risk of death in SHF.
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