摘要
目的观察血浆转化生长因子β1(TGF-β1)及脑钠肽(BNP)在舒张性心力衰竭(简称心衰)患者与非心衰住院患者之间的表达差异,探讨TGF-β1、BNP、TGF-β1/BNP与舒张功能指标、心脏超声舒张功能障碍分级及纽约心脏病学会(NYHA)心功能分级的相关性。方法选取北京朝阳医院2016年10月至2017年11月住院的舒张性心衰患者,同时选择年龄及性别相匹配的非心衰住院患者为对照。使用心脏超声频谱多普勒、组织多普勒方法测量舒张功能指标(E/e′),根据美国超声心动图学会指南评价舒张功能障碍分级,根据NYHA心功能分级标准评价心功能,使用酶联免疫吸附法测定血浆TGF-β1和BNP水平,并分析各指标间的相关性及绘制受试者工作特征(ROC)曲线。结果共纳入186例患者,其中舒张性心衰组114例,其中男性54例、女性60例,年龄为(70.75±11.45)岁;对照组72例,其中男性41例、女性31例,年龄为(68.74±10.86)岁。舒张性心衰组患者血浆TGF-β1[(77.68±42.31)ng/L]及BNP[(1153.84±564.96)ng/L]水平明显高于对照组[(18.76±13.70)、(264.07±179.43)ng/L,t=15.62、13.77,P均<0.01]。Pearson相关分析显示,血浆TGF-β1与E/e′呈显著正相关(r=0.582,P<0.01),血浆BNP与E/e′呈弱正相关(r=0.261,P<0.01),TGF-β1/BNP与E/e′无相关性(r=0.081,P>0.05)。Spearman相关分析显示,血浆TGF-β1、BNP与舒张功能障碍分级呈正相关(r=0.473、0.417,P均<0.01),TGF-β1/BNP与其无相关性(r=0.062,P>0.05);血浆TGF-β1、BNP与NYHA心功能分级呈弱正相关(r=0.309、0.326,P均<0.01),TGF-β1/BNP与NYHA心功能分级无相关性(r=0.011,P>0.05)。多因素logistic回归分析显示,TGF-β1、BNP均是舒张性心衰发生的独立预测因子(OR=1.264、2.283,P<0.05或<0.01)。BNP辅助诊断舒张性心衰的ROC曲线下面积为0.937±0.064,TGF-β1的ROC曲线下面积为0.597±0.042,二者比较差异有统计学意义(P<0.01)。结论舒张性心衰患者血浆TGF-β1及BNP水平升高;TGF-β1及BNP与舒张功能指标E/e′、舒张功能障碍分级及NYHA心功能分级具有相关性,其水平升高是舒张性心衰发生的独立预测因子,对舒张性心衰均有辅助诊断价值,且BNP的诊断价值优于TGF-β1。
Objective To investigate the expressions of transforming growth factor β1(TGF-β1)and brain natrium peptide(BNP)in patients with diastolic heart failure(DHF),and to explore the correlation between plasma levels of TGF-β1,BNP and TGF-β1/BNP with parameter of diastolic function,diastolic dysfunction and New York Heart Association(NYHA)classification of cardiac function.Methods Hospitalized patients with DHF from October 2016 to November 2017 in Beijing Chaoyang Hospital were selected as subjects.At the same time,the age-and gender-matched non-heart failure hospitalized patients were selected as the control.The diastolic function index(E/e')was measured using cardiac ultrasound spectral Doppler and tissue Doppler methods.The diastolic dysfunction classification was evaluated according to the American Society of Echocardiography guidelines.Cardiac function was evaluated with NYHA classification.The levels of plasma TGF-β1 and BNP were measured with method of enzyme linked immunosorbent assay(ELISA).The correlation between the indicators was analyzed and the receiver operating characteristic(ROC)curve was drawn.Results A total of 186 patients were enrolled,including 114 patients as DHF group [54 males and 60 females,mean age(70.75 ± 11.45)years old] and 72 cases as control group [41 males and 31 females,mean age(68.74 ± 10.86)years old].The levels of TGF-β1 [(77.68 ± 42.31)ng/L] and BNP [(1 153.84 ± 564.96)ng/L] in patients with DHF were significantly higher than those of the control group[(18.76 ± 13.70),(264.07 ± 179.43)ng/L,t = 15.62,13.77,P<0.01].Pearson correlation analysis showed that level of plasma TGF-β1 had a significant liner correlation with index E/e'(r = 0.582,P<0.01),level of plasma BNP had a low-degree liner correlation with index E/e'(r = 0.261,P<0.01),and TGF-β1/BNP had no correlation with index E/e'(r = 0.081,P>0.05).Spearman correlation analysis showed that the levels of TGF-β1 and BNP were significantly correlated with diastolic dysfunction grading(r = 0.473,0.417,P<0.01),while TGF-β1/BNP had no correlation with diastolic dysfunction grading(r = 0.062,P>0.05).Plasma TGF-β1 and BNP had low-degree correlation with NYHA classification of heart failure(r = 0.309,0.326,P<0.01),TGF-β1/BNP had no correlation with NYHA classification of heart failure(r = 0.011,P>0.05).Logistic analysis showed that both plasma TGF-β1 and BNP were independent predictors of DHF(OR = 1.264,2.283,P<0.05 or<0.01).The area under ROC curve(AUC)of BNP for prediction of DHF was 0.937 ± 0.064,and TGF-β1 was 0.597 ± 0.042.AUC areas of BNP and TGF-β1 were significantly different(P<0.01).Conclusions The expressions of plasma TGF-β1 and BNP in patients with DHF are higher than those without DHF.The levels of plasma TGF-β1 and BNP are significantly correlated with index E/e',diastolic dysfunction grading and NYHA classification.Both elevated BNP and TGF-β1 levels are independent predictors of DHF.Both plasma BNP and TGF-β1 have auxiliary diagnostic value on DHF and the diagnostic value of plasma BNP is greater than plasma TGF-β1.
作者
池洪杰
尚香玉
焦洁
范一帆
孙兰兰
张恩翔
梁超
孟宪辰
姜维
Chi Hongjie;Shang Xiangyu;Jiao jie;Fan Yifan;Sun Lanlan;Zhang Enxiang;Liang Chao;Meng Xianchen;Jiang Wei(Heart Centre,Beijing Chaoyang Hospital,Capital Medical University,Beijing Key Laboratory of Hypertension,Beijing 100020,China;Department of Echocardiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Statistics,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《中华地方病学杂志》
CAS
CSCD
北大核心
2019年第4期282-287,共6页
Chinese Journal of Endemiology
基金
国家自然科学基金(81200194)
北京市卫生系统高层次卫生技术人才学科骨干(2015-3-028)
首都医科大学基础临床研究(16JL27)
北京朝阳医院1351人才项目(CYXX-2017-03)
北京市自然科学基金(7122072).
关键词
心力衰竭
舒张性
脑钠肽
转化生长因子Β
生物标志物
Heart failure,diastolic
Brain natrium peptide
Transforming growth factor beta
Bio-marker
作者简介
通信作者:姜维,Email:jiangwei@l63.com,电话:010-85231400.
