Significance of S100A12 in predicting adverse clinical endpoints in patients with CHF
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摘要: 目的 探讨S100A12在预测慢性心力衰竭(CHF)患者不良临床终点事件中的意义。方法 前瞻性收集2019年1月—2020年1月上海市静安区市北医院诊疗的CHF患者200例，通过18个月的随访发现，出现不良心脑血管事件(MACCE)的患者有63例，设为MACCE发生组; 未出现MACCE事件的患者有137例，设为MACCE未发生组。比较两组患者的临床相关资料，分析S100A12水平与临床特征的相关性，并对S100A12高表达和低表达、BNP高表达和低表达的CHF患者进行生存分析，同时分析CHF患者发生MACCE的影响因素。结果 MACCE发生组与MACCE未发生组中性别构成比、BMI、LVEDD、LVESD、EF、LVMI、SBP、DBP、TG、TC、LDL-C、HDL-C及NT-proBNP水平比较，差异无统计学意义(P>0.05); MACCE发生组患者的BNP和S100A12水平明显高于MACCE未发生组，eGFR值明显低于MACCE未发生组，差异均有统计学意义(P< 0.05); S100A12与年龄(r=0.217，P=0.005)和BNP(r=0.317，P< 0.001)呈正相关性，与eGFR(r=-0.214，P=0.013)呈负相关性; S100A12高表达组的生存期明显短于S100A12低表达组(x2=8.537，P< 0.001); BNP高表达组的生存期明显短于BNP低表达组(χ2=5.194，P=0.005)。年龄、BNP和S100A12是预测CHF患者MACCE的独立危险因素(P< 0.05)，而eGFR是预测MACCE的保护因素(P< 0.05)。结论 S100A12和BNP一样是预测MACCE的独立危险因素, 并且随着S100A12的升高, CHF死亡率明显增加，说明S100A12对于预后判断可能具有明显价值。Abstract: Objective To explore the significance of S100A12 in predicting adverse clinical endpoints in patients with chronic heart failure(CHF).Methods Two hundred patients with CHF Treated in Shibei Hospital of Shanghai Jing'an District from January 2019 to January 2020 were retrospectively collected. Through 18 months of follow-up, it was found that 63 patients with adverse cardiovascular and cerebrovascular events(MACCE) were in the MACCE occurrence group, and 137 patients without MACCE events were in the MACCE non occurrence group. The clinical data of the two groups were compared, the correlation between S100A12 level and clinical characteristics was analyzed, the survival of CHF patients was analyzed, and the influencing factors of MACCE in CHF patients were analyzed.Results There was no significant difference in gender, BMI, LVEDd, LVESD, EF, LVMI, SBP, DBP, TG, TC, LDL-C, HDL-C and NT proBNP between MACCE occurrence group and MACCE non occurrence group(P>0.05). The values of BNP and S100A12 in MACCE group were significantly higher than those in non MACCE group, and the value of EGFR in MACCE group was significantly lower than that in non MACCE group; S100A12 was positively correlated with age(r=0.217,P=0.005) and BNP(r=0.317,P< 0.001), and negatively correlated with EGFR(r=-0.214,P=0.013); The survival time of S100A12 high expression group was significantly shorter than that of S100A12 low expression group(x2=8.537,P< 0.001); Age, BNP and S100A12 were independent risk factors for predicting MACCE(P< 0.05), while EGFR was a protective factor for predicting MACCE(P< 0.05).Conclusion S100A12, like BNP, is an independent risk factor for predicting MACCE, and with the increase of S100A12, the mortality of CHF increases significantly, indicating that S100A12 may have obvious value for prognosis judgment.
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表 1 两组患者的临床相关资料比较
X±S 观察指标 MACCE发生组(n=63) MACCE未发生组(n=137) t/χ2 P 男/女(例) 46/17 98/39 0.018 0.089 年龄/岁 66.19±9.26 61.83±9.04 3.146 0.041 BMI 23.71±0.89 23.27±0.76 0.725 0.429 LVEDD/mm 56.63±10.85 54.42±3.18 0.817 0.172 LVESD/mm 42.94±10.36 41.13±2.68 0.643 0.396 EF/% 42.52±12.2 43.63±4.47 0.398 0.672 LVMI/(g·m-2) 139.13±39.87 137.29±11.53 0.729 0.311 SBP/mmHg 132.54±20.16 132.48±14.57 0.651 0.463 DBP/mmHg 75.96±10.81 77.46±9.64 0.927 0.129 TG/(mmol·L-1) 1.42±0.83 1.43±1.01 1.613 0.074 TC/(mmol·L-1) 4.10±1.07 4.41±0.69 2.875 0.079 LDL-C /(mmol·L-1) 1.07±0.35 1.18±0.29 2.549 0.084 HDL-C/(mmol·L-1) 2.41±0.85 2.68±0.56 1.628 0.073 BNP/(mg·L-1) 1297.23±1158.35 549.79±156.21 39.846 < 0.001 NT-proBNP/(pg·mL-1) 3576.14±1365.28 2873.16±1425.84 2.986 0.071 eGFR/(mL·min-1·1.73m-2) 79.39±18.64 82.22±10.15 3.882 0.011 S100A12/(ng·mL-1) 76.27±27.39 42.75±2.28 14.632 < 0.001 
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表 2 两组患者合并症及用药情况比较
例(%) 项目 MACCE发生组(63例) 未发生MACCE组(137例) χ2 P 合并症 冠心病 41(65.08) 91(66.42) 0.365 0.721 高血压 38(60.32) 83(60.58) 0.279 0.826 糖尿病 19(30.16) 38(27.74) 0.316 0.769 扩张型心肌病 14(22.22) 31(22.63) 0.294 0.794 心房纤颤 19(30.16) 38(27.74) 0.637 0.492 药物 阿司匹林 33(52.38) 69(50.36) 0.318 0.726 血管紧张素转换酶抑制剂 35(55.56) 77(56.20) 0.295 0.714 β受体阻滞剂 45(71.43) 90(65.69) 1.026 0.085 钙通道阻滞剂 14(22.22) 39(28.47) 0.835 0.231 利尿剂 39(61.90) 77(56.20) 0.793 0.253 他汀类药物 36(57.14) 79(57.66) 0.324 0.817 硝酸盐类 38(60.32) 74(54.01) 1.167 0.076 地高辛 21(33.33) 48(35.04) 0.436 0.694
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表 4 CHF患者发生MACCE的影响因素分析
影响因素 单因素分析 多因素分析 HR(95%CI) P HR(95%CI) P 年龄 1.126(0.913~1.579) 0.049 1.223(1.000~1.862) 0.037 BNP 1.416(1.039~2.037) 0.014 1.275(1.133~1.571) 0.008 eGFR 0.953(0.902~0.996) 0.012 0.929(0.903~0.996) 0.017 S100A12 1.729(1.003~2.058) 0.009 1.853(1.001~2.194) 0.005
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