摘要
目的通过代谢组学方法分析急性心力衰竭(acute heart failure,AHF)患者与对照组代谢组学差异,寻找新的代谢标志物,并对其诊断的价值进行验证。方法本研究为单中心病例对照研究。纳入人群为2018年01月至2019年06月河南省人民医院急诊入院的89例AHF患者,对照组为年龄、性别进行匹配的80例同期无心衰和舒张功能障碍人群。收集研究对象空腹股动脉血样本,进行定性定量处理,建立正交偏最小二乘方-判别分析模型,进行代谢物的诊断分析。结果与对照组相比,AHF组更多伴有冠心病、高血压、糖尿病、房颤、吸烟史,肌酐、尿素、脑利钠肽(B-type Natriuretic Peptide,BNP)、心率水平偏高,左室射血分数、血钠、白蛋白水平偏低。对AHF和对照组进行代谢物分析,发现两组代谢差异显著,其中腺嘌呤、N乙酰-L-谷氨酸、假尿苷、γ-谷氨酰半胱氨酸对AHF的诊断具有一定的价值,诊断AHF的曲线下面积(area under the curve,AUC)分别为0.995、0.932、0.920、0.900,BNP诊断AHF的AUC值为0.978。结论AHF组和对照组代谢存在显著差异,差异代谢物涉及多种物质;与BNP相比,腺嘌呤、N乙酰-L-谷氨酸、假尿苷、γ-谷氨酰半胱氨酸对AHF具有相似的诊断价值。
Objective To investigate the difference of metabolomics between acute heart failure(AHF)patients and control.To find and validate new metabolic biomarkers.Methods This was a single-center case-control study which included 89 acute heart failure patients admitted to the emergency department of Henan Provincial People's Hospital from January 2018 to June 2019.Eighty people without heart failure and diastolic dysfunction were enrolled as control group whose age and sex were matched to the study group.The fasting blood samples were collected from femoral arterial.Qualitative and quantitative analyses of plasma metabolites were performed in 2 groups by high performance liquid chromatography tandem mass spectrometry(UHPLC-MS),Orthogonal partial least squares-discriminant analysis(OPLS-DA)model and ROC curve method were applied.Results Compared with the control group,we found that AHF group had higher likelihood to groups with coronary heart disease(37%vs.7%,P<0.001),hypertension(58%vs.28%,P<0.001),diabetes(33%vs.18%,P=0.033),atrial fibrillation(24%vs.4%,P<0.001),smoking history(42%vs.18%,P=0.001),and that AHF group had higher creatinine level[(121.6±78.4)vs.(69.0±21.0),P<0.001],higher urea level[(11.5±7.6)vs.(6.2±2.0),P<0.001],higher heart rate[(92±23)vs.(78±14),P<0.001],hypoproteinemia[(32.4±5.2)vs.(40.4±2.2),P<0.001],and significantly increased BNP level[(4200±5229)vs.(100±68),P<0.001],lower left ventricular ejection fraction[(45±8)vs.(57±6),P<0.001],low serum sodium level(P<0.001).The metabolites of AHF group were significantly different from those of the control group.The metabolites involved amino acids,fatty acids,lipids,nucleosides and their derivatives.Adenine,N-acetyl-L-glutamic,pseudouridine and Gamma-Glutamylcysteine had certain diagnostic value for AHF comparing to control.The AUC were 0.995,0.932,0.920 and 0.900.And the AUC value for BNP diagnosis of AHF is 0.978.Conclusions There were significant differences in metabolism between AHF group and control group including multiple substances.Adenine,N-acetyl-L-glutamic,pseudouridine and Gamma-Glutamylcysteine has similar diagnostic value compared with BNP for diagnosing AHF.
作者
徐雅欣
崔英杰
白伟民
张胜龙
彭海林
秦历杰
Xu Yaxin;Cui Yingjie;Bai Weimin;Zhang Shenglong;Peng Hailin;Qin Lijie(Department of Emergency,Henan Provincial People′s Hospital,People′s Hospital of Zhengzhou University,People′s Hospital of Henan University,Zhengzhou 450000,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2021年第4期485-490,共6页
Chinese Journal of Emergency Medicine
关键词
急性心力衰竭
代谢组学
脑利钠肽
Acute heart failure
Metabolomics
B-type Natriuretic Peptide
