摘要
目的探讨白细胞介素(interleukin,IL)-6、-17联合可溶性基质裂解素-2(soluble suppression oftumorigenicity 2,sST2)预测慢性心力衰竭急性发作患者发生利尿剂抵抗的价值。方法慢性心力衰竭急性发作患者89例,入院后静脉注射呋塞米40 mg/次,1次/8 h,共2次。应用呋塞米发生利尿剂抵抗者49例为利尿剂抵抗组,未发生利尿剂抵抗者40例为非利尿剂抵抗组。比较2组血清IL-6、IL-17、sST2、尿酸、肌酐、氨基末端脑钠肽前体、谷丙转氨酶、谷草转氨酶、肌酸激酶、肌酸激酶同工酶水平;采用多因素logistic回归分析慢性心力衰竭急性发作患者发生利尿剂抵抗的危险因素,并建立利尿剂抵抗的回归方程;绘制ROC曲线,评估回归方程评价慢性心力衰竭急性发作患者发生利尿剂抵抗的效能。结果利尿剂抵抗组血清IL-6[(38.83±8.12)ng/L]、IL-17[(42.15±8.69)ng/L]、sST2[(43.61±12.28)μg/L]、尿酸[(474.89±146.25)μmol/L]、肌酐[(101.66±66.23)μmol/L]、氨基末端脑钠肽前体[15774.00(10972.80,21655.37)ng/L]水平高于非利尿剂抵抗组[(32.40±7.66)ng/L、(34.56±10.71)ng/L、(36.22±11.02)μg/L、(393.45±148.78)μmol/L、(77.57±31.66)μmol/L、4982.05(3695.22,6367.68)ng/L](P<0.05),谷草转氨酶[(42.40±15.24)u/L]、谷丙转氨酶[(37.42±13.57)u/L]、肌酸激酶[(108.76±29.87)u/L]、肌酸激酶同工酶[(18.23±5.78)u/L]与非利尿剂抵抗组[(39.62±14.31)、(34.61±15.49)、(98.67±36.12)、(16.74±4.92)u/L]比较差异无统计学意义(P>0.05)。尿酸(OR=1.004,95%CI:1.001~1.008,P=0.028)、IL-6(OR=1.086,95%CI:1.014~1.162,P=0.014)、IL-17(OR=1.095,95%CI:1.005~1.116,P=0.031)、sST2(OR=1.046,95%CI:1.001~1.092,P=0.047)是慢性心力衰竭急性发作患者发生利尿剂抵抗的影响因素。建立利尿剂抵抗的回归方程logit(P)=-8.545+0.004×尿酸+0.082×IL-6+0.057×IL-17+0.045×sST2,回归方程评估慢性心力衰竭急性发作患者发生利尿剂抵抗的Youden指数最大值为0.532,AUC为0.860(95%CI:0.714~0.899,P<0.001),灵敏度为85.7%,特异度为67.5%。结论尿酸、IL-6、IL-17、sST2水平增高是慢性心力衰竭急性发作患者应用呋塞米后发生利尿剂抵抗的危险因素,建立的回归方程对慢性心力衰竭急性发作患者是否发生利尿剂抵抗有较高的预测价值。
Objective To investigate the value of interleukin(IL)-6,IL-17 and soluble suppression of tumorigenicity 2(sST2)to the diagnosis of diuretic resistance in patients with acute episode of chronic heart failure.Methods Eighty-nine patients with acute episode of chronic heart failure were given intravenous injection of furosemide 40 mg immediately after admission,followed by a repetition at an interval of 8 h,totally twice,and the patients were divided into 49 patients with diuretic resistance after treated with furosemide(diuretic resistance group)and 40 patients without diuretic resistance(non-diuretic resistance group).The serum levels of IL-6,IL-17,sST2,uric acid(UA),serum creatinine,N-terminal-proBNP,glutamic pyruvic transaminase,glutamic oxaloacetic transaminase,creatine kinase and creatine kinase isoenzyme were compared between two groups.Multivariate logistic regression was used to analyze the risk factors for diuretic resistance in patients with acute episode of chronic heart failure,and the regression equation of diuretic resistance was established.ROC curve was drawn to evaluate the efficacy of regression equation on diuretic resistance in patients with acute acute episode of chronic heart failure.Results The levels of IL-6((38.83±8.12)ng/L),IL-17((42.15±8.69)ng/L),sST2((43.61±12.28)μg/L),UA((474.89±146.25)μmol/L),serum creatinine((101.66±66.23)μmol/L)and N-terminal-proBNP(15774.00(10972.80,21655.37)ng/L)in diuretic resistance group were significantly higher than those in non-diuretic resistance group((32.40±7.66)ng/L,(34.56±10.71)ng/L,(36.22±11.02)μg/L,(393.45±148.78)μmol/L,(77.57±31.66)μmol/L,4982.05(3695.22,6367.68)ng/L)(P<0.05),and the levels ofglutamic oxaloacetic transaminase((42.40±15.24)u/L vs.(39.62±14.31)u/L),glutamic pyruvic transaminase((37.42±13.57)u/L vs.(34.61±15.49)u/L),creatine kinase((108.76±29.87)u/L vs.(98.67±36.12)u/L),creatine kinase isoenzyme((18.23±5.78)u/L vs.(16.74±4.92)u/L)(P>0.05).UA(OR=1.004,95%CI:1.001-1.008,P=0.028),IL-6(OR=1.086,95%CI:1.014-1.162,P=0.014),IL-17(OR=1.095,95%CI:1.005-1.116,P=0.031)and sST2(OR=1.046,95%CI:1.001-1.092,P=0.047)were the risk factors for diuretic resistance in patients with acute episode of chronic heart failure.The regression equation of diuretic resistance was logit(P)=-8.545+0.004×UA+0.082×IL-6+0.057×IL-17+0.045×sST2.The maximum Youden index was 0.52,AUC was 0.860(95%CI:0.714-0.899,P<0.001),the sensitivity was 85.7% and the specificity was 67.5%.Conclusion The elevated levels of UA,IL-6,IL-17 and sST2 are the risk factors for diuretic resistance in patients with acute episode of chronic heart failure after furosemide administration and the regression equation has a high predictive value.
作者
王露朝
柴小奇
陈玉军
李子杰
WANG Luzhao;CHAI Xiaoqi;CHEN Yujun;LI Zijie(Department of Cardiology,Hanzhong Central Hospital,Hanzhong 723000,China)
出处
《中华实用诊断与治疗杂志》
2020年第6期573-576,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
陕西省卫生健康科研基金(2018D013)
汉中市中心医院院级科研项目(YK17010)。
