老年心力衰竭患者血清Gal-3、sST2和ProDH水平及其临床意义

Serum Gal-3, sST2, ProDH levels and their clinical significance in elderly patients with heart failure

摘要:

目的]探讨老年心力衰竭患者血清半乳糖凝集素3(Gal-3)、可溶性基质溶素2(sST2)及脯氨酸脱氢酶(ProDH)的水平及其临床意义。 [方法]采用单中心回顾性队列研究设计,选取2022年1月—2023年10月在本院接受诊疗的老年心力衰竭患者165例作为研究对象,设为观察组,另选取同期于本院进行体检的心功能正常且无心脏病的老年人120例,设为对照组。对比两组Gal-3、sST2和ProDH水平,绘制ROC曲线分析Gal-3、sST2和ProDH水平对老年心力衰竭患者的诊断价值,利用Spearman秩相关分析Gal-3、sST2和ProDH与老年心力衰竭的相关性。同时将观察组根据预后情况分为预后不良组(n＝49)和预后良好组(n＝116),对比两组一般资料,采用Logistic回归模型分析影响老年心力衰竭预后不良的相关危险因素；绘制ROC曲线分析相关危险因素对老年心力衰竭预后不良的预测价值。 [结果]观察组Gal-3和sST2水平显著高于对照组,ProDH水平显著低于对照组,差异均具有统计学意义(P＜0.05)。ROC曲线分析结果显示,Gal-3、sST2和ProDH及三者联合诊断对于诊断老年心力衰竭均具有统计学意义(P＜0.05),其中联合诊断的诊断价值较高(AUC=0.996,95%CI:0.992~1.000,灵敏度为0.970,特异度为0.975)。经Spearman秩相关分析显示,Gal-3和sST2与老年心力衰竭呈显著性正相关(P＜0.05),ProDH与老年心力衰竭呈显著性负相关(P＜0.05)。Logistic回归模型多因素分析显示,NYHA心功能Ⅳ级、Gal-3高水平、sST2高水平是老年心力衰竭预后不良的独立危险因素(P＜0.05),左心室射血分数(LVEF)升高、ProDH高水平是其保护因素(P＜0.05)。ROC曲线分析结果显示,NYHA心功能分级、LVEF、Gal-3、sST2、ProDH及联合预测对于预测老年心力衰竭预后不良均具有统计学意义(P＜0.05),其中联合预测的预测价值较高(AUC=0.983,95%CI:0.969~0.998,灵敏度为0.939,特异度为0.948)。 [结论]本研究首次在老年心力衰竭人群中系统联合分析Gal-3、sST2和ProDH的预测效能,发现三者联合对诊断和预后评估具有显著临床价值。NYHA心功能Ⅳ级、Gal-3高水平、sST2高水平是老年心力衰竭预后不良的独立危险因素,LVEF升高、ProDH高水平是其保护因素,均具备一定预测价值,且联合预测价值更高。

Abstract:

Aim To investigate the levels and clinical significance of serum galectin-3 (Gal-3), soluble suppression of tumorigenicity 2 (sST2) and proline dehydrogenase (ProDH) in elderly patients with heart failure. Methods Using a single-center retrospective cohort study design, 165 elderly patients with heart failure who were diagnosed and treated in our hospital from January 2022 to October 2023 were selected as the observation group, and 120 elderly patients with normal cardiac function and no heart disease who underwent physical examination in our hospital during the same period were selected as the control group. Serum Gal-3, sST2, and ProDH levels were compared between the two groups. The ROC curve was drawn to analyze the diagnostic value of Gal-3, sST2 and ProDH levels in elderly patients with heart failure. Spearman rank correlation was used to analyze the correlation between Gal-3, sST2, ProDH and heart failure in the elderly. At the same time, the observation group was divided into a poor prognosis group (n＝49) and a good prognosis group (n＝116) according to the prognosis. The general data of the two groups were compared. The associated risk factors influencing the poor prognosis of elderly heart failure were examined using Logistic regression model. ROC curve was created to examine the predictive value of associated risk factors for a poor prognosis of elderly heart failure. Results The levels of Gal-3 and sST2 were significantly higher in observation group than those in control group, the level of ProDH was significantly lower than in control group, with statistical significance (P＜0.05). ROC curve results showed that Gal-3, sST2, ProDH and combined diagnosis were statistically significant for the diagnosis of heart failure in the elderly (P＜0.05). The AUC of the combined diagnosis was 0.6,5%CI was 0.992～1.000, the sensitivity was 0.970, the specificity was 0.975, and the diagnostic value was higher. Spearman rank correlation analysis showed that Gal-3 and sST2 were positively correlated with heart failure in the elderly (P＜0.05), and ProDH was negatively correlated with heart failure in the elderly (P＜0.05). Multivariate analysis of Logistic regression model showed that NYHA cardiac function grade Ⅳ, high level of Gal-3 and high level of sST2 were independent risk factors for poor prognosis of elderly patients with heart failure (P＜0.05), and elevated left ventricular ejection fraction (LVEF) and high level of ProDH were protective factors (P＜0.05). ROC curve results showed that NYHA cardiac function classification, LVEF, Gal-3, sST2, ProDH and combined prediction were statistically significant in predicting the poor prognosis of elderly heart failure (P＜0.05). The AUC of combined prediction was 0.3,5%CI was 0.969～0.998, the sensitivity was 0.939, the specificity was 0.948, and the predictive value was higher. Conclusion In this study, the combined predictive efficacy of Gal-3, sST2 and ProDH was systematically analyzed in elderly patients with heart failure for the first time, and it was found that the combination of the three had significant clinical value in diagnosis and prognosis evaluation. NYHA cardiac function grade Ⅳ, high level of Gal-3 and high level of sST2 were independent risk factors for poor prognosis of elderly patients with heart failure. Elevated LVEF and high level of ProDH were protective factors, all of which have certain predictive value, and the combined predictive value is higher.