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夏合那孜·艾亚斯丁.高敏C反应蛋白升高预示致心律失常性心肌病终末期心力衰竭事件风险[J].内科急危重症杂志,2025,31(6):526-530
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| DOI：10.11768/nkjwzzzz20250608 |
| 中文关键词: 高敏C反应蛋白 致心律失常性心肌病 终末期心力衰竭事件 氨基末端B型利钠肽前体 左室射血分数 |
| 英文关键词: |
| 基金项目:国家自然科学基金（82470373）；中央高水平医院临床科研业务费（2025-GSP-QN-36） |
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| 中文摘要: |
| 摘要 目的：探讨血清高敏C反应蛋白（hsCRP）水平与致心律失常性心肌病（ACM）患者临床特征及预后的关系，评估其对终末期心力衰竭事件（ESHF）风险的预测价值。方法：回顾性纳入临界诊断及确诊ACM的患者328例，根据基线hsCRP实验室标准分为低水平组（≤3 mg/L，251例）和高水平组（＞3 mg/L，77例）。收集病史、检查及检验资料，并比较2组间差异。采用Spearman相关分析、受试者工作特征（ROC）曲线分析、Kaplan-Meier生存分析及Cox比例风险模型评估hsCRP与心功能关联及对ESHF的预测价值。结果：研究人群中，男性占68.9%，致病/可能致病基因突变检出率为44.8%。hsCRP高水平组患者心功能及左室射血分数（LVEF）较差，右心室扩张与氨基末端B型利钠肽前体（NT-proBNP）水平显著升高（P均＜0.05），但既往恶性室性心律失常发生率比较，差异无统计学意义（P＞0.05）。Spearman相关性分析显示，hsCRP与LVEF呈负相关（r=-0.257，P＜0.001），与NT-proBNP（r=0.307，P＜0.001）及右心室内径（r=0.115, P=0.039）呈正相关。基因阳性及阴性患者hsCRP水平相近，但在不同心室受累患者中分布不同，在双心室受累患者中水平更高（趋势P=0.005）。ROC曲线分析示，hsCRP预测1、3及5年ESHF事件的曲线下面积（AUC）分别为0.640、0.662、0.654。Kaplan-Meier分析示，hsCRP高水平组随访期间无ESHF生存率显著降低（平均生存97.2 vs 150.5个月, P＜0.001）。多因素Cox回归示，hsCRP分别独立于传统心室结构及心力衰竭指标(LVEF、右心室扩张及NT-proBNP)与ESHF风险显著相关（hsCRP作连续及分类变量，P均＜0.05）。矫正年龄、性别、NT-proBNP及右心室扩张后，hsCRP水平仍与ESHF风险独立相关（连续变量HR：1.071, 95%CI：1.011～1.135，P=0.020；分类变量HR：1.833, 95%CI：1.115～3.014,P=0.017）。结论：血清hsCRP升高与ACM患者的心力衰竭和不良结局密切相关，可作为潜在生物标志物用于辅助ACM患者未来ESHF事件的预测。 |
| 英文摘要: |
| Abstract Objective: To investigate the association between serum high-sensitivity C-reactive protein (hsCRP) levels and the clinical outcomes in arrhythmogenic cardiomyopathy (ACM), and to evaluate the predictive value of hsCRP for end-stage heart failure (ESHF) events. Methods: A total of 328 patients with borderline or definite ACM were retrospectively enrolled. Patients were categorized into low-level (≤3 mg/L, n=251) and high-level (>3 mg/L, n=77) groups based on baseline hsCRP levels. Clinical data were collected and compared. Spearman correlation, receiver operating characteristic (ROC) curve analysis, Kaplan-Meier survival analysis, and Cox proportional hazards models were employed to assess the association between hsCRP, cardiac function, and ESHF risk. Results: Among 328 patients (68.9% male), 44.8% carried pathogenic/likely pathogenic gene variants. The high hsCRP group showed worse cardiac NYHA class, lower left ventricular ejection fraction (LVEF), greater right ventricular enlargement, and significantly higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, but there was no statistically significant difference in incidence of previous malignant ventricular arrhythmias (P> 0.05). The hsCRP was correlated negatively with LVEF (r=-0.257, P< 0.001) and positively with NT-proBNP (r=0.307, P<0.001) and right ventricular diameter (r=0.115, P=0.039). The hsCRP levels were not influenced by positive gene states, but varied across structural involvement patterns, with higher levels in biventricular involvement (trend P=0.005). ROC curve analysis indicated modest discriminatory ability for predicting ESHF at 1st, 3rd, and 5th year \[areas under the curve (AUCs) of 0.640, 0.662, and 0.654\]. Kaplan-Meier analysis demonstrated significantly reduced ESHF-free survival in the high hsCRP group (mean survival 97.2 vs. 150.5 months, P<0.001). Multivariable Cox regression showed that hsCRP remained significantly associated with ESHF risk independent of traditional ventricular structural and heart failure indices (LVEF, right ventricular dilatation, and NT-proBNP), whether analyzed as a continuous or categorical variable (both P<0.05).After adjustment for age, sex, NT-proBNP and right-ventricular dilatation, hsCRP remained independently associated with ESHF risk (continuous parameter HR: 1.071, 95 %CI: 1.011-1.135, P= 0.020; categorical parameter HR: 1.833, 95%CI: 1.115-3.014, P=0.017). Conclusion: Elevated serum hsCRP levels are closely associated with heart failure and adverse outcomes in patients with ACM, suggesting its potential role as a biomarker for predicting the risk of future ESHF events in this population. |
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