摘要
目的 探讨心电图QRS波时限联合血清白细胞介素11(IL-11)和可溶性尿激酶型纤溶酶原激活物受体(suPAR)对老年慢性心力衰竭(CHF)患者预后的预测价值。方法 选取2020年1月至12月新疆医科大学第五附属医院心血管内科诊治的236例老年CHF患者为研究对象。根据随访12个月内主要不良心血管事件(MACE)的发生情况,分为MACE组(n=76例)和非MACE组(n=160例)。比较2组患者的一般资料及入组时QRS波时限、血清IL-11和suPAR水平。采用SPSS 22.0软件对数据进行统计分析。采用受试者工作特征(ROC)曲线分析QRS波时限、血清IL-11和suPAR水平对老年CHF患者预后的预测价值。采用Kaplan-Meier曲线分析不同QRS波时限、血清IL-11和suPAR水平患者预后的差异。采用多因素logistic回归分析老年CHF患者预后的影响因素。结果 与非MACE组比较,MACE组患者QRS波时限[(126.74±9.63)和(110.29±9.47)ms]、IL-11[(64.05±14.49)和(46.26±11.86)pg/ml]和suPAR[(3.64±0.99)和(2.32±0.85)ng/ml]水平显著升高,差异有统计学意义(P<0.01)。ROC曲线分析显示,QRS波时限、IL-11和suPAR预测老年CHF患者MACE的曲线下面积分别为0.886、0.838和0.842,最佳截断点分别为121.07ms、52.24pg/ml和2.88 ng/ml。3者联合预测的曲线下面积为0.968,灵敏度为94.74%,特异度为91.87%。Kaplan-Meier曲线分析显示,不同QRS波时限、IL-11和suPAR的老年CHF患者MACE发生率差异有统计学意义(P<0.001)。logistic回归分析显示,左室射血分数(OR=0.784,95%CI 0.684~0.898)、纽约心脏病协会心功能分级(OR=2.561,95%CI 1.044~6.284)、QRS波时限(OR=1.195,95%CI 1.105~1.292)、IL-11(OR=1.115,95%CI 1.059~1.174)和suPAR(OR=4.316,95%CI 2.012~9.260)是老年CHF患者发生MACE的独立影响因素。结论 QRS波时限、血清IL-11和suPAR是老年CHF患者MACE的独立危险因素,三者联合检测对老年CHF患者预后有更高的预测价值。
Objective To investigate the predictive value of QRS duration on electrocardiogram combined with serum levels of interleukin(IL)-11 and soluble urokinase type plasminogen activator receptor(suPAR)in the prognosis of elderly patients with chronic heart failure(CHF).Methods A total of 236 elderly CHF patients diagnosed and treated in our department of cardiovascular diseases from January to December 2020 were recruited in this study.According to the occurrence of major adverse cardiovascular events(MACE)within 12 months of follow-up,they were divided into MACE group(n=76)and non-MACE group(n=160).The general data,QRS duration,and serum IL-11 and suPAR levels were compared between the 2 groups.SPSS 22.0 was used for statistical analysis.The predictive values of QRS duration and serum IL-11 and suPAR levels on the prognosis of elderly CHF patients were analyzed by receiver operating characteristic(ROC)curve.Kaplan-Meier curve was used to analyze the prognosis of the patients with different QRS duration and serum IL-11 and suPAR levels.Multivariate logistic regression analysis was adopted to analyze the prognostic factors of the patients.Results Compared with non-MACE group,the MACE group had significantly longer QRS duration[(126.74±9.63)vs(110.29±9.47)ms]and higher levels of IL-11[(64.05±14.49)vs(46.26±11.86)pg/ml]and suPAR[(3.64±0.99)vs(2.32±0.85)ng/ml](P<0.01).ROC curve analysis showed that the area under the curve of QRS duration,IL-11 and suPAR to predict MACE in elderly CHF patients was 0.886,0.838 and 0.842,respectively,and the best cut-off value was 121.07 ms,52.24 pg/ml and 2.88 ng/ml,respectively.The area under the curve of the combination of 3 indicators was 0.968,the sensitivity was 94.74%,and the specificity was 91.87%.Kaplan-Meier survival analysis showed that there were significant differences in the incidence of MACE among the elderly CHF patients with different QRS duration and IL-11 and suPAR levels(P<0.001).Logistic regression analysis indicated that left ventricular ejection fraction(OR=0.784,95%CI 0.684-0.898),cardiac function classification of New York Heart Association(OR=2.561,95%CI 1.044-6.284),QRS duration(OR=1.195,95%CI 1.105-1.292),IL-11(OR=1.115,95%CI 1.059-1.174)and suPAR(OR=4.316,95%CI 2.012-9.260)were independent influencing factors for MACE in elderly patients with CHF.Conclusion QRS duration and serum IL-11 and suPAR levels are independent risk factors for MACE in elderly patients with CHF.Combined detection of these 3 indicators has higher predictive value for the prognosis of elderly patients with CHF.
作者
杨丽
王艳红
孟静
YANG Li;WANG Yan-Hong;MENG Jing(Department of Function,Fifth Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,Xinjiang Uygur Autonomous Region,China;Department of Cardiology,Fifth Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,Xinjiang Uygur Autonomous Region,China)
出处
《中华老年多器官疾病杂志》
2022年第7期526-531,共6页
Chinese Journal of Multiple Organ Diseases in the Elderly
