内质网应激标志物在老年射血分数降低的心力衰竭中的预测作用及其与急性代偿失调的关系

刘宁; 张贝; 张铁; 时维琼; 冯晖

doi:10.13201/j.issn.1001-1439.2020.10.010

内质网应激标志物在老年射血分数降低的心力衰竭中的预测作用及其与急性代偿失调的关系

- 1. 乌鲁木齐市友谊医院心血管内二科(乌鲁木齐, 830049);
- 2. 乌鲁木齐市友谊医院肾内科;
- 3. 乌鲁木齐市友谊医院耳鼻喉科;
- 4. 乌鲁木齐市友谊医院心胸肿瘤科
基金项目:
乌鲁木齐市卫生和计划生育委员会科技计划项目(No:201804)

详细信息

通讯作者: 刘宁,E-mail:liuning788@163.com

中图分类号: R541.6

收稿日期: 2020-06-15

修回日期: 2020-07-29

Prediction value of endoplasmic reticulum stress markers and its relationship with acute decompensation in elderly patients with reduced ejection fraction heart failure

- 1. Department of Cardiology;
- 2. Department of Nephrology;
- 3. Department of Otorhinolaryngology;
- 4. Department of Cardiothoracic Oncology, Urumqi Friendship Hospital, Urumqi, 8300049, China

More Information

Corresponding author: LIU Ning, E-mail: liuning788@163.com

Received Date: 15 June 2020

Revised Date: 29 July 2020

摘要

摘要: 目的:探究内质网应激标志物蛋白激酶样内质网激酶(PERK)、C/EBP同源蛋白(CHOP)、葡萄糖调节蛋白78(GRP78)在老年射血分数降低的心力衰竭(HFrEF)中的预测作用及其与急性代偿失调的关系。方法:选取2017年1月—2020年1月在本院就诊的HFrEF老年患者216例为HFrEF组,同期无急性、亚急性或慢性病史的老年者187例为对照组。收集受试者基线资料[性别、年龄、肺动脉收缩压(sPAP)、左心室射血分数(LVEF)等]及实验室参数[肌酸激酶同工酶(CK-MB)、C反应蛋白(CRP)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)等)],比较内质网应激标志物水平,并通过ROC曲线分析其对HFrEF的预测价值。对HFrEF患者均随访3个月,以急性失代偿性心力衰竭(ADHF)为终点,分析内质网应激标志物对ADHF的预测及住院时间的影响。结果:HFrEF组PERK水平高于对照组,CHOP、GRP78水平均显著低于对照组(均P<0.05)。ROC曲线分析显示,PERK预测HFrEF的曲线下面积(AUC)为0.684,敏感度为87.5%,特异度为44.4%;CHOP预测HFrEF的AUC为0.716,敏感度为44.0%,特异度为79.7%;GRP78预测HFrEF的AUC为0.846,敏感度为54.2%,特异度为95.7%。216例HFrEF患者发生ADHF 68例(31.48%),ADHF组CHOP、GRP78水平均显著高于非ADHF组(均P<0.05)。ROC曲线分析显示,CHOP、GRP78预测ADHF的AUC分别为0.755、0.630,截点值分别为63.95 pg/ml、233.45 pg/ml。线性回归分析显示,年龄、CHOP能够正向预测ADHF患者的住院时间(年龄:B=0.083,95%CI:0.008~0.157,P<0.05;CHOP:B=0.064,95%CI:0.043~0.086,P<0.05)。结论:内质网应激标志物CHOP、GRP78对HFrEF具有一定预测准确性;且CHOP可预测ADHF,其与年龄可共同预测ADHF患者住院时间。
- 心力衰竭 /
- 射血分数降低 /
- 急性代偿失调 /
- 内质网应激标志物
Abstract: Objective: To explore the prediction value of endoplasmic reticulum stress marker protein kinase-like endoplasmic reticulum kinase(PERK), C/EBP homologous protein(CHOP), or glucose-regulated protein 78(GRP78) and its relationship with acute decompensation in elderly patients with reduced ejection fraction heart failure(HFrEF). Method: A total of 216 elderly patients with HFrEF, who were treated in our hospital from January 2017 to January 2020, were selected as the HFrEF group. 187 elderly patients with no history of acute, subacute or chronic diseases were selected as the control group. Baseline data[sex, age, systolic pulmonary artery pressure(sPAP), left ventricular ejection fraction(LVEF), etc. ] and laboratory parameters[creatine kinase-MB(CK-MB), C-reactive protein(CRP), total cholesterol(TC), high density liptein cholesterol(HDL-C), etc. ]were collected. Levels of endoplasmic reticulum stress markers were compared, and the ROC curve was used to analyse the predictive value for HFrEF. All patients with HFrEF were followed up for 3 months. The primary end point was the incidence of acute decompensated heart failure(ADHF). The values of endoplasmic reticulum stress markers in predicting ADHF and the length of hospital stay was analyzed. Result: The level of PERK in the HFrEF group was higher than that in the control group, and the levels of CHOP and GRP78 were lower than those in the control group(all P<0.05). ROC curve analysis showed that the area under the curve(AUC) of PERK in predicting HFrEF was 0.684, the sensitivity was 87.5%, and the specificity was 44.4%; the AUC of CHOP in predicting HFrEF was 0.716, the sensitivity was 44.0%, and the specificity was 79.7%; the AUC of GRP78 in predicting HFrEF was 0.846, the sensitivity was 54.2%, and the specificity was 95.7%. Among 216 patients with HFrEF, 68(31.48%) cases occurred ADHF, and the levels of CHOP and GRP78 in the ADHF group were higher than those in the non-ADHF group(both P<0.05). ROC curve analysis showed that the AUC of CHOP and GRP78 in predicting ADHF were 0.755 and 0.630, the cutoff values were 63.95 pg/ml and 233.45 pg/ml, respectively. Linear regression analysis showed that age and CHOP positively predicted the hospitalization time in ADHF patients(age: B=0.083, 95%CI: 0.008-0.157, P<0.05; CHOP: B=0.064, 95%CI: 0.043-0.086, P<0.05).Conclusion: Endoplasmic reticulum stress markers CHOP and GRP78 have a certain prediction accuracy for HFrEF; and CHOP can predict ADHF, which together with age can predict the length of hospitalization in ADHF patients.
- heart failure /
- reduced ejection fraction /
- acute decompensation /
- endoplasmic reticulum stress markers

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