Value of combined detection of serum CST and Gal-3 in evaluating short-term prognosis of patients with acute decompensated heart failure after discharge
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摘要: 目的 探讨血清儿茶酚抑素(CST)、半乳糖凝集素-3(Gal-3)联合检测对急性失代偿性心力衰竭(ADHF)患者出院后短期预后的评估价值。方法 采用前瞻性研究方法，选择2019年1月5日-2021年8月30日期间我院收治的ADHF患者为病例组，另选择同期在我院体检健康的志愿者98例为对照组，对比病例组患者入院时、对照组体检时血清CST、Gal-3水平。根据患者出院后30 d内是否出现不良事件将其分为预后不良组(因心力衰竭再入院或全因死亡)与预后良好组，对比预后不良组、预后良好组患者的临床资料、实验室指标和入院时血清CST、Gal-3水平，分析ADHF患者出院后短期内发生不良事件的危险因素，分析部分指标及联合检测对ADHF患者出院后短期内发生不良事件的预测价值。结果 病例组患者入院时血清CST、Gal-3水平显著高于对照组(P < 0.05)；预后不良组患者的美国纽约心脏病学会(NYHA)心功能分级Ⅳ级比例及血清N末端B型利钠肽原(NT-proBNP)、CST、Gal-3水平均显著高于预后良好组(P < 0.05)，左心室射血分数(LVEF)显著低于预后良好组(P < 0.05)。Logistic回归分析显示，LVEF降低、NT-proBNP升高、CST升高、Gal-3升高是患者出院后短期内不良事件发生的危险因素(P < 0.05)。受试者工作特征(ROC)曲线分析显示，联合检测患者出院后短期内发生不良事件的曲线下面积(AUC)为0.859、敏感度为0.833，特异度为0.883。结论 血清CST和Gal-3是ADHF患者出院后短期不良预后的危险因素，检测入院时血清CST、Gal-3水平有助于预测患者出院后短期不良预后，联合检测的预测价值更高。
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关键词:
- 儿茶酚抑素 /
- 半乳糖凝集素-3 /
- 急性失代偿性心力衰竭 /
- 预后
Abstract: Objective To investigate the value of combined detection of serum catechinstatin(CST) and galectin-3(Gal-3) in evaluating short-term prognosis of patients with acute decompensated heart failure(ADHF) after discharge.Methods Using the prospective research method, patients with ADHF treated in the people's hospital of Inner Mongolia Autonomous Region from January 5, 2019 to August 30, 2021 were selected as the case group, and 98 healthy volunteers who underwent physical examination in our hospital in the same period were included in the control group. The levels of serum CST and Gal-3 in the case group at admission and in the control group at physical examination were compared. According to whether there were adverse events within 30 days after discharge, the patients were divided into poor prognosis group(readmission due to heart failure or all-cause death) and good prognosis group. The clinical data, laboratory indexes, serum CST and Gal-3 levels at admission of patients in poor prognosis group and good prognosis group were compared, the risk factors of adverse events in a short time after discharge of ADHF patients were analyzed, and the serum CST The predictive value of Gal-3 level for adverse events in the short term after discharge in patients with ADHF.Results The levels of serum CST and Gal-3 in the case group at admission were significantly higher than those in the control group(P < 0.05). The proportion of New York Heart Association(NYHA) cardiac function classification was grade IV and the levels of serum N-terminal pro-B-type natriuretic peptide(NT-proBNP), CST and Gal-3 in the poor prognosis group were significantly higher than those in the good prognosis group(P < 0.05), and the left ventricular ejection fraction(LVEF) was significantly lower than that in the good prognosis group(P < 0.05). logistic regression analysis showed that the decrease of LVEF, the increase of NT-proBNP, CST, Gal-3 were the risk factors of adverse events in the short term of patients(P < 0.05). The receiver operating characteristic(ROC) curve analysis showed that the area under curve(AUC) of combined prediction for short-term adverse events after discharge was 0.859, the sensitivity was 0.833, and the specificity was 0.883.Conclusion Serum CST and Gal-3 are risk factors for short-term poor prognosis in patients with ADHF after discharge. Detecting the levels of serum CST and Gal-3 at admission is helpful to predict the short-term poor prognosis after discharge, and the predictive value of combined detection is higher.-
Key words:
- catecholastatin /
- galectin-3 /
- acute decompensated heart failure /
- prognosis
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表 1 两组临床资料、实验室指标和血清CST、Gal-3水平比较
例(%) 指标 预后良好组(77例) 预后不良组(48例) t(χ2) P 年龄/岁 61.09±5.03 61.86±5.28 1.110 0.268 BMI 22.56±3.19 22.79±3.24 0.531 0.596 性别 (0.016) 0.899 男 41(53.25) 25(52.08) 女 36(46.75) 23(29.87) 吸烟史 (0.780) 0.376 有 23(29.87) 18(37.50) 无 54(70.13) 30(62.50) 高脂血症史 (0.047) 0.827 有 32(41.56) 19(40.63) 无 45(58.44) 29(59.37) 高血压史 (0.485) 0.486 有 45(58.44) 25(52.08) 无 32(41.56) 23(29.87) 糖尿病史 (0.094) 0.758 有 31(40.26) 18(37.50) 无 46(59.74) 30(62.50) NYHA心功能分级 (7.323) 0.007 Ⅲ级 54(70.13) 22(45.83) Ⅳ级 23(29.87) 26(54.17) 应用β受体阻滞剂 (0.351) 0.553 是 49(63.64) 28(58.33) 否 28(36.36) 20(41.67) 应用ARB或ACEI (0.645) 0.422 是 55(71.43) 31(64.58) 否 22(28.57) 17(35.42) 应用利尿剂 (0.180) 0.671 是 51(66.23) 30(62.50) 否 26(33.77) 18(37.50) 应用醛固酮 (0.781) 0.377 是 54(70.13) 30(62.50) 否 23(29.87) 18(37.50) 住院时间/d 12.57±2.36 13.14±2.21 1.345 0.181 LVEF/% 52.79±6.24 40.82±4.03 11.831 < 0.001 白细胞/(×109·L-1) 8.09±1.14 8.42±1.23 1.527 0.129 血红蛋白/(g·L-1) 125.27±17.29 129.15±18.36 1.192 0.236 C反应蛋白/(mg·L-1) 61.28±6.07 61.59±5.82 0.282 0.778 NT-proBNP/(ng·L-1) 2 253.18±247.86 3 189.61±526.57 13.423 < 0.001 CST/(ng·mL-1) 4.93±1.19 8.45±1.62 13.968 < 0.001 Gal-3/(ng·mL-1) 12.42±2.39 26.51±3.68 25.969 < 0.001 注：ARB、ACEI为血管紧张素转换酶抑制剂。 
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表 2 ADHF患者出院后短期内发生不良事件的logistic回归分析
指标 赋值 β SE Wald χ2 P OR OR 95%CI 常数 -0.203 0.106 3.668 0.055 NYHA心功能分级 1：Ⅳ级，0：Ⅲ级 0.301 0.403 0.557 0.455 1.351 0.613~2.976 LVEF 1：≥50%，0：<50% -0.962 0.275 12.254 < 0.001 0.382 0.223~0.655 NT-proBNP 1：≥2700 ng/L，0：<2700 ng/L 1.065 0.286 13.842 < 0.001 2.901 1.655~5.084 CST 1：≥6 ng/mL，0：<6 ng/mL 0.723 0.259 7.784 0.005 2.061 1.240~3.426 Gal-3 1：≥20 ng/mL，0：<20 ng/mL 1.276 0.363 12.370 < 0.001 3.582 1.759~7.293
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表 3 各指标预测ADHF患者出院后发生短期不良预后的ROC曲线分析
指标 AUC(95%CI) 阈值 敏感度 特异度 约登指数 准确度(n/N) NT-proBNP 0.778(0.631~0.929) 2600 ng/L 0.813 0.753 0.566 0.776(97/125) LVEF 0.790(0.613~0.960) 50% 0.792 0.780 0.572 0.784(98/125) CST 0.716(0.495~0.928) 6 ng/mL 0.708 0.688 0.396 0.695(87/125) Gal-3 0.799(0.654~0.942) 20 ng/mL 0.750 0.831 0.581 0.800(100/125) 联合检测 0.859(0.744~0.972) 0.833 0.883 0.716 0.864(108/125)
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