首页|血清PTX3、CK-MB水平对慢性失代偿心力衰竭患者容量负荷的评估价值

血清PTX3、CK-MB水平对慢性失代偿心力衰竭患者容量负荷的评估价值

The evaluation value of serum PTX3 and CK-MB levels on volume load in patients with chronic decompensated heart failure

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目的 探讨血清正五聚蛋白3(PTX3)、肌酸激酶同工酶MB(CK-MB)水平对慢性失代偿心力衰竭(CDHF)患者容量负荷的评估价值.方法 选取2019年7月至2022年7月于邢台市中心医院就诊的300例CDHF患者,根据患者容量平衡水平将其分为容量负荷过载组(n=182)和非容量负荷过载组(n=118).对比分析两组临床资料,利用受试者工作特征(ROC)曲线分析血清PTX3、CK-MB水平对CDHF患者容量负荷的评估价值,利用单因素分析两组患者的临床疾病特征,采用logistic回归分析CDHF患者容量负荷的影响因素,构建列线图模型并验证.结果 容量负荷过载组患者BMI、腰围、收缩压、舒张压、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、C反应蛋白(CRP)、尿酸(UA)、胰岛素抵抗指数(HOMA-IR)均高于非容量负荷过载组,差异均有统计学意义(均P<0.05).容量负荷过载组患者的PTX3、CK-MB、肺毛细血管楔压(PCWP)、CVP水平高于非容量负荷过载组,清蛋白、血红蛋白、红细胞比容低于非容量负荷过载组,差异均有统计学意义(均P<0.05).ROC曲线显示,PTX3、CK-MB预测CDHF患者容量负荷过载的曲线下面积(AUC)为0.795、0.718,灵敏度分别为86.2%、83.7%,特异度分别为65.4%、68.6%,预测准确性较高;两项联合预测的AUC为0.817、灵敏度为92.5%、特异度为70.6%,预测准确性高于PTX3(Z=3.812,P<0.05)和CK-MB(Z=3.365,P<0.05).PTX3、CK-MB、清蛋白、血红蛋白、红细胞比容、PCWP、中心静脉压(CVP)均为CDHF患者的容量负荷状态的影响因素(均P<0.05),据此建立的列线图风险预测模型在临床治疗上有着高准确性和强适用性.结论 血清PTX3、CK-MB水平为CDHF患者发生容量过载的影响因素,联合清蛋白、血红蛋白、红细胞比容、PCWP、CVP等指标构建的列线图模型对CDHF的容量负荷状态具有较高的预测价值.
Objective To explore the evaluation value of serum levels of positive pentameric protein 3(PTX3)and creatine kinase isoenzyme MB(CK-MB)on volume load in patients with chronic decompensated heart failure(CDHF).Methods A total of 300 CDHF patients who visited the Xingtai Central Hospital from July 2019 to July 2022 were selected and divided into a capacity overload group(n=182)and a non capacity overload group(n=118)based on their capacity balance level.Two clinical data sets were compared and analyzed.The receiver operating characteristic(ROC)curve was used to analyze the evaluation value of serum PTX3 and CK-MB levels on the volume load of CDHF patients.The clinical disease characteristics of the two groups of patients were analyzed using univariate analysis,and the influencing factors of volume load of CDHF patients were analyzed using logistic regression.A column chart model was constructed and validated.Results The body mass index(BMI),waist circumference,systolic blood pressure,diastolic blood pressure,fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),C-reactive protein(CRP),uric acid(UA),homeostasis model assessment of insulin resistance(HOMA-IR)of patients in the capacity overload group were higher than those in the non-capacity overload group,and the differences were statistically significant(all P<0.05).The PTX3,CK-MB,pulmonary capillary wedge pressure(PCWP),and CVP levels of patients in the capacity overload group were higher than those in the non-capacity overload group,while albumin,hemoglobin,and hematocrit were lower than those in the non-capacity overload group,and the differences were statistically significant(all P<0.05).The ROC curve showed that the area under the curve(AUC)of PTX3 and CK-MB for predicting capacity overload in CDHF patients are 0.795 and 0.718,with sensitivity of 86.2%and 83.7%,specificity of 65.4%and 68.6%,respectively,indicating high predictive accuracy;The AUC of the two joint predictions is 0.817,the sensitivity was 92.5%,and the specificity was 70.6%.The prediction accuracy was higher than PTX3(Z=3.812,P<0.05)and CK-MB(Z=3.365,P<0.05).PTX3,CK-MB,albumin,hemoglobin,hematocrit,PCWP,and central venous pressure(CVP)were all influencing factors of volume load status in CDHF patients(all P<0.05).The column chart risk prediction model established based on these factors had high accuracy and strong applicability in clinical treatment.Conclusions Serum PTX3 and CK-MB levels are influencing factors for volume overload in CDHF patients.A column chart model constructed in combination with indicators such as albumin,hemoglobin,hematocrit,PCWP,and CVP has high predictive value for the volume overload status of CDHF.

Heart failurePentraxin 3Creatine kinase,MB formVolume overload

曹明善、王春娣、胡小倩、孟令慧、武瑜丰、刘欢、杨华

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邢台市中心医院检验科,邢台 054000

临西县人民医院心内科,临西 054900

邢台市人民医院检验科,邢台 054031

心力衰竭 正五聚蛋白3 肌酸激酶,MB型 容量负荷

邢台市重点研发计划项目

2020ZC286

2024

中国医师杂志
中华医学会 湖南省医学会

中国医师杂志

CSTPCD
影响因子:0.876
ISSN:1008-1372
年,卷(期):2024.26(1)
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