摘要
目的:探讨血清白细胞介素-11(IL-11)和脑源性神经营养因子(BDNF)水平对老年慢性心力衰竭(CHF)患者近期预后的临床价值,为临床诊治提供理论依据。方法:选取2017-10-2018-08海口市人民医院心内科诊治的189例老年CHF患者。根据NYHA分级,将其分为NYHAⅡ级组(66例)、NYHAⅢ级组(75例)和NYHAⅣ级组(48例);根据随访1年内是否发生不良心血管事件(MACE),将其分为MACE组(60例)和非MACE组(129例)。检测血清IL-11和BDNF水平,采用ROC曲线分析血清IL-11和BDNF水平对老年CHF患者近期预后的预测价值,应用Kaplan-Merier法绘制老年CHF患者近期预后的MACE累计发生曲线,同时应用多因素Logistic回归分析老年CHF患者MACE发生的影响因素。结果:MACE组血清IL-11水平高于非MACE组[(61.19±13.63)pg/ml∶(45.76±11.47)pg/ml],血清BDNF水平低于非MACE组[15.98(13.02,18.59)ng/ml∶19.87(17.09,22.48)ng/ml],均差异具有统计学意义(均P<0.01)。血清IL-11水平随着NYHA分级呈上升趋势(P<0.01),而血清BDNF水平呈下降趋势(P<0.01)。ROC曲线显示:血清IL-11预测老年CHF患者近期预后的曲线下面积为0.809,截断值为54.21 pg/ml,灵敏度为75.01%,特异度为78.29%;BDNF预测老年CHF患者近期预后的曲线下面积为0.770,截断值为17.71 ng/ml,灵敏度为73.33%,特异度为70.54%。Kaplan-Meier曲线分析显示,IL-11≥54.21 pg/ml和BDNF≤17.71 ng/ml时,老年CHF患者MACE累积发生率显著高于IL-11<54.21 pg/ml和BDNF>17.71 ng/ml者(P<0.001)。Logistic回归分析显示,NYHA分级(OR=2.385,P<0.05)、IL-11(OR=2.936,P<0.01)和BDNF(OR=0.535,P<0.01)是老年CHF患者发生MACE的影响因素。结论:血清IL-11和BDNF水平与老年CHF患者病情严重程度和预后密切相关,可作为预测老年CHF患者近期预后的标志物。
Objective:To explore the clinical value of serum interleukin-11(IL-11)and brain-derived neurotrophic factor(BDNF)level in the short-term prognosis of elderly patients with chronic heart failure(CHF),so as to provide a theoretical basis for clinical diagnosis and treatment.Method:From October 2017 to August 2018,189 elderly patients with CHF were selected.All included patients were divided into NYHAⅡgroup(n=66),NYHAⅢgroup(n=75)and NYHAⅣgroup(n=48)according to NYHA classification,and were also divided into major adverse cardiac events(MACE)group(n=60)and non-MACE group(n=129)according to whether MACE occurred within one year of follow-up.Serum IL-11 and BDNF levels were measured.The ROC curve was used to analyze the predictive value of serum IL-11 and BDNF levels for the short-term prognosis,and the survival curve of the short-term prognosis was drawn by Kaplan-Merier method.Multivariate Logistic regression was used to analyze the influencing factors of MACE.Result:The serum IL-11 level in MACE group was higher than that in non-MACE group[(61.19±13.63)pg/ml vs(45.76±11.47)pg/ml,P<0.01],while the serum BDNF level in MACE group was lower than that in non-MACE group[15.98(13.02,18.59)ng/ml vs 19.87(17.09,22.48)ng/ml,P<0.01].Serum IL-11 level showed an upward trend with NYHA classification(P<0.01),while serum BDNF level showed a downward trend(P<0.01).The ROC curve showed that the area under the curve of serum IL-11 predicting the short-term prognosis in elderly CHF patients was 0.809,the cut-off value was 54.21 pg/ml,the sensitivity was 75.01%,and the specificity was 78.29%;While the area under the curve of BDNF was 0.770,the cut-off value was 17.71 ng/ml,the sensitivity was 73.33%,the specificity was 70.54%.The Kaplan-Meier curve analysis showed that the cumulative incidence of MACE in elderly CHF patients with IL-11≥54.21 pg/ml and BDNF≤17.71 ng/ml were significantly higher than those with IL-11<54.21 pg/ml and BDNF>17.71 ng/ml(P<0.001).Logistic regression analysis showed that NYHA classification(OR=2.385,P<0.05),IL-11(OR=2.936,P<0.01)and BDNF(OR=0.535,P<0.01)were the influencing factors of MACE in elderly CHF patients.Conclusion:Serum IL-11 and BDNF levels are closely related to the severity and prognosis of elderly patients with CHF,and can be used as markers for predicting the short-term prognosis.
作者
蒋宏亮
刘启明
张福伟
陈漠水
JIANG Hongliang;LIU Qiming;ZHANG Fuwei;CHEN Moshui(Department of Cardiology,The Second Xiangya Hospital of Central South University,Changsha,410011,China;Department of Cardiology,Haikou People's Hospital,Central South University Xiangya School of Medicine Affiliated Haikou Hospital)
出处
《临床心血管病杂志》
CAS
北大核心
2020年第2期142-147,共6页
Journal of Clinical Cardiology
基金
海南省卫生计生行业科研项目(No:18A200135).
关键词
心力衰竭
慢性
白细胞介素11
脑源性神经营养因子
病情
预后
chronic heart failure
interleukin 11
brain-derived neurotrophic factor
pathogenetic condition
prognosis
