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李纯.血清葡萄糖调节蛋白-78、氧化三甲胺、CD137水平可用于预测急性失代偿期心力衰竭患者预后[J].内科急危重症杂志,2025,31(4):351-355
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| DOI：10.11768/nkjwzzzz20250413 |
| 中文关键词: 心力衰竭急性失代偿期 血清葡萄糖调节蛋白-78 氧化三甲胺 CD137 预后 |
| 英文关键词: |
| 基金项目:长沙市2021年度指导性科技计划项目（kzd21095） |
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| 摘要点击次数: 9 |
| 全文下载次数: 14 |
| 中文摘要: |
| 摘要 目的：探讨血清葡萄糖调节蛋白-78（GRP78）、氧化三甲胺（TMAO）、CD137在急性失代偿期心力衰竭（ADHF）患者中的表达，并分析其对预后的预测价值。方法：选取127例ADHF患者为ADHF组，另选取同期收治的80例慢性稳定性心力衰竭患者为稳定组。比较2组血清GRP78、TMAO、CD137水平及心功能相关指标 [心率、收缩压、舒张压、左心室射血分数（LVEF）、左心室舒张末期内径（LVEDd）、美国纽约心脏病学会（NYHA）分级、N末端脑钠肽前体（NT-proBNP）]，并分析其相关性。随访6个月，根据预后将ADHF组分为预后良好亚组和预后不良亚组，绘制受试者工作特征（ROC）曲线，分析血清GRP78、TMAO、CD137对ADHF患者预后不良的预测效能。结果：ADHF组血清GRP78、TMAO、CD137水平、心率、收缩压、舒张压、NT-proBNP水平高于稳定组，NYHA分级Ⅲ级、Ⅳ级占比高于稳定组，LVEF低于稳定组（P均＜0.05）；ADHF患者血清GRP78、TMAO、CD137水平与心率、收缩压、舒张压、NT-proBNP水平、NYHA分级呈正相关，与LVEF呈负相关（P均＜0.05）；预后不良亚组患者血清GRP78、TMAO、CD137水平高于预后良好亚组（P均＜0.05）；血清GRP78、TMAO、CD137水平单独预测ADHF患者预后不良的曲线下面积（AUC)分别为0.763（95%CI：0.678～0.835）、0.776（95%CI：0.692～0.846）、0.723（95%CI：0.635～0.800）（P均＜0.05）；三者联合预测ADHF患者预后不良的AUC为0.914（95%CI：0.850～0.957），灵敏度为88.64%，特异性为87.34%。结论：ADHF患者血清GRP78、TMAO、CD137水平改变与心力衰竭病情相关，可用于评估心功能和预测预后。 |
| 英文摘要: |
| Abstract Objective: To investigate the expression of serum glucose-regulated protein-78 (GRP78), trimetlylamine oxide (TMAO), and CD137 in patients with acute decompensated heart failure (ADHF), and analyze their prognostic predictive value, providing a reference for clinical diagnosis and treatment. Methods: A total of 127 patients with ADHF in the Department of Geriatrics of the Third Hospital of Changsha from March 2021 to August 2023 were selected as the ADHF group, and 80 patients with chronic stable heart failure admitted to our hospital during the same period were selected as the stable group. Serum GRP78, TMAO, CD137 levels and cardiac function related indexes [heart rate, systolic blood pressure, diastolic blood pressure, left ventricular ejection fraction (LVEF), left ventricular end-diastolic internal diameter (LVEDd), New York Heart Association (NYHA) classification, N-terminal pro-brain natriuretic peptide precursor (NT-proBNP)] in the two groups were compared and correlation was analyzed. At 6-month follow-up, the ADHF group was divided into a good prognosis subgroup and a poor prognosis subgroup according to the occurrence of adverse prognostic events, and the predictive efficacy of serum GRP78, TMAO, and CD137 in predicting poor prognosis in ADHF patients was analyzed. Results: The levels of serum GRP78, TMAO, CD137, heart rate, systolic blood pressure, diastolic blood pressure, and NT-proBNP in the ADHF group were higher than those in the stable group, and the proportion of NYHA class III and IV was higher than that in the stable group. The LVEF in the ADHF group was lower than that in the stable group (P<0.05). Serum GRP78, TMAO, and CD137 in patients with ADHF were positively correlated with heart rate, systolic blood pressure, diastolic blood pressure, NT-proBNP, and NYHA classification, and negatively correlated with LVEF (P<0.05). The levels of serum GRP78, TMAO, and CD137 in the poor prognosis subgroup were higher than those in the good prognosis subgroup (P<0.05). The AUCs of GRP78, TMAO, and CD137 alone for predicting poor prognosis in patients with ADHF were 0.763 (95%CI: 0.678-0.835), 0.776 (95%CI: 0.692-0.846), and 0.723 (95%CI: 0.635-0.800), respectively (P<0.05). The AUC of serum GRP78, TMAO, and CD137 combined to predict poor prognosis in ADHF patients was 0.914 (95%CI: 0.850-0.957), with a sensitivity of 88.64% and a specificity of 87.34% (P< 0.05). Conclusion: The changes in serum levels of GRP78, TMAO, and CD137 are associated with the severity of heart failure and can be used as effective indicators for evaluating cardiac function and predicting prognosis in patients with ADHF. |
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