冠心病并发心力衰竭行PCI术患者血清CT-1和ANGPTL3水平的变化及临床意义

Changes in serum CT-1 and ANGPTL3 levels in patients with coronary heart disease and heart failure undergoing PCI and their clinical significance

摘要:

目的]检测冠心病(CHD)并发心力衰竭(HF)行经皮冠状动脉介入治疗(PCI)术患者血清心肌营养素1(CT-1)和血管内皮生长因子样蛋白3(ANGPTL3)水平的变化,并分析两者与预后的关系。 [方法]选取2022年3月—2023年3月于医院行PCI术的CHD并发HF患者199例。比较不同NYHA心功能分级患者术前血清CT-1和ANGPTL3水平；PCI后随访统计预后情况,将出现主要不良心血管事件(MACE)的患者纳入预后不良组,其余纳入预后良好组。比较预后不良组和预后良好组一般资料及血清CT-1和ANGPTL3水平；采用Logistic回归模型分析CHD并发HF患者PCI术后预后不良的影响因素；分析血清CT-1和ANGPTL3单独及联合的预测价值。 [结果]与心功能Ⅰ级患者比较,心功能Ⅱ级、Ⅲ级、Ⅳ级患者血清CT-1和ANGPTL3水平升高(P＜0.05)；与心功能Ⅱ级患者比较,Ⅲ级和Ⅳ级患者血清CT-1和ANGPTL3水平升高(P＜0.05)；与心功能Ⅲ级患者比较,Ⅳ级患者血清CT-1和ANGPTL3水平升高(P＜0.05)。Spearman相关性分析显示,血清CT-1和ANGPTL3水平与NYHA心功能分级呈正相关(r＝0.518,95%CI:0.408~0.613,P＜0.001；r＝0.737,95%CI:0.666~0.794,P＜0.001)。患者预后不良率17.93%。与预后良好组比较,预后不良组血清CT-1和ANGPTL3水平升高(P＜0.05)。Logistic回归模型分析显示,吸烟、糖尿病、病变血管数量≥3支、院外不规律用药、血清CT-1和ANGPTL3水平是CHD并发HF患者预后不良的影响因素(P＜0.05)。ROC曲线分析显示,血清CT-1和ANGPTL3联合预测CHD并发HF患者预后不良的灵敏度和曲线下面积(AUC)均高于它们单独预测,特异度与单独预测基本相当。 [结论]血清CT-1和ANGPTL3水平在CHD并发HF行PCI术患者中异常升高,两者与患者心功能及预后密切相关。

Abstract:

Aim To detect the changes of serum cardiotrophin-1 (CT-1) and angiopoietin-like protein 3 (ANGPTL3) levels in patients with coronary heart disease (CHD) complicated with heart failure (HF) after percutaneous coronary intervention (PCI), and analyze their relationship with prognosis. Methods 199 patients with CHD complicated with HF who underwent PCI in the Second Affiliated Hospital of Zhengzhou University from March 2022 to March 2023 were selected. The serum CT-1 and ANGPTL3 levels of patients with different New York Heart Association (NYHA) cardiac function grades were compared before surgery. The prognosis was followed up after PCI, and the patients who had major adverse cardiovascular event (MACE) were included in the poor prognosis group, and the rest were included in the good prognosis group. The general data and serum CT-1 and ANGPTL3 levels were compared between the poor prognosis group and the good prognosis group. Logistic regression model was used to analyze the influencing factors of poor prognosis after surgery in patients with CHD and HF. The predictive value of serum CT-1 and ANGPTL3 alone and in combination were analyzed. Results Compared with the patients with cardiac function grade Ⅰ, the serum CT-1 and ANGPTL3 levels of the patients with cardiac function grade Ⅱ, Ⅲ and Ⅳ were increased (P＜0.05). Compared with the patients with cardiac function grade Ⅱ, the serum CT-1 and ANGPTL3 levels of the patients with cardiac function grade Ⅲ and Ⅳ were increased (P＜0.05). Compared with the patients with cardiac function grade Ⅲ, the serum CT-1 and ANGPTL3 levels of the patients with acrdiac function grade Ⅳ were increased (P＜0.05). Spearman correlation analysis showed that the serum CT-1 and ANGPTL3 levels were positively correlated with NYHA cardiac function grade (r＝0.8,5%CI:0.408~0.613, P＜0.001, r＝0.7,5%CI:0.666~0.794, P＜0.001). The poor prognosis rate of patients was 17.93%. Compared with the good prognosis group, the serum CT-1 and ANGPTL3 levels of the poor prognosis group were increased (P＜0.05). Logistic regression model analysis showed that smoking, diabetes, lesion vessel number≥3, irregular medication outside the hospital, serum CT-1 and ANGPTL3 levels were the influencing factors of poor prognosis in patients with CHD complicated with HF (P＜0.05). ROC curve analysis showed that the sensitivity and area under the curve (AUC) of combined serum CT-1 and ANGPTL3 levels for predicting poor prognosis of patients with CHD complicated with HF were higher than those of either marker alone, while the specificity was basically similar to that of single-marker prediction. Conclusion Serum CT-1 and ANGPTL3 levels are abnormally elevated in patients with CHD complicated with HF after PCI, and are closely related to the cardiac function and prognosis.