2021 年第 4 期 第 16 卷

血清糖类抗原125和N末端B型脑钠肽前体对射血分数保留的心力衰竭的诊断与疗效判定及预后的评估价值

Evaluation of serum carbohydrate antigen 125 and N-terminal pro-brain natriuretic peptide in diagnosis, efficacy judgment and prognosis of heart failure with preserved ejection fraction

作者：崔泽岩1孙倩2周红霞3

英文作者：Cui Zeyan1 Sun Qian2 Zhou Hongxia3

单位：1河北省保定市第二医院老年病科071000；2河北省保定市第二医院心内科071000；3河北省保定市第五医院烧伤科071000

英文单位：1Department of Geriatrics the No.2 Hospital of Baoding Hebei Province Baoding 071000 China; 2Department of Cardiology the No.2 Hospital of Baoding Hebei Province Baoding 071000 China; 3Burn Department the No.5 Hospital of Baoding Hebei Province Baoding 071000 China

关键词：

英文关键词：Heartfailurewithpreservedejectionfraction;Carbohydrateantigen125;N-terminalpro-brainnatriureticpeptide;Diagnosis;Prognosis

• 摘要：

• 目的 探讨血清糖类抗原125(CA125)和N末端B型脑钠肽前体(NT-proBNP)对射血分数保留的心力衰竭(HFpEF)的诊断、疗效判定及预后的评估价值。方法 回顾性分析2017年2月至2019年1月保定市第二医院收治的124例HFpEF患者（HFpEF组）及98例舒张功能异常患者（舒张功能异常组）临床资料，并纳入48例同期入院体检者作为健康对照组。比较3组血清CA125、NT-proBNP水平差异，使用受试者工作特征(ROC)曲线评估血清CA125、NT-proBNP及二者联合检测对HFpEF的诊断价值；分析不同临床疗效HFpEF患者治疗后血清CA125、NT-proBNP水平变化情况；并根据HFpEF患者1年内临床终点事件发生情况分为未发生临床终点事件组（预后良好组）及发生临床终点事件组（预后不良组），比较其出院时血清CA125、NT-proBNP水平，使用ROC曲线评估血清CA125、NT-proBNP及二者联合检测对HFpEF预后的预测价值。结果 HFpEF组血清CA125、NT-proBNP水平均明显高于舒张功能异常组和健康对照组［（23.7±8.8）kU/L比（15.0±4.5）、（9.4±2.5）kU/L，（597±213）ng/L比（165±52）、（112±38）ng/L］，舒张功能异常组明显高于健康对照组（均P＜0.05）。ROC曲线分析结果显示，血清CA125、NT-proBNP均对HFpEF具有较高诊断价值［曲线下面积（AUC）=0.854、0.979，均P＜0.05］，其截断值分别为19.28 kU/L和286.27 ng/L，且联合检测的AUC（0.987）高于单一检测。治疗1个月后，124例HFpEF患者显效44例、有效56例、无效24例。显效者治疗后血清CA125、NT-proBNP水平均明显低于有效和无效者，有效者明显低于无效者（均P＜0.05）。出院1年内，发生临床终点事件23例（18.5%），纳入预后不良组；未发生临床终点事件101例（81.5%），纳入预后良好组；预后不良组出院时血清CA125、NT-proBNP水平均明显高于预后良好组（均P＜0.001）。ROC曲线分析结果显示，出院时血清CA125、NT-proBNP均对HFpEF预后具有较高预测价值（AUC=0.752、0.840，均P＜0.05），其截断值分别为14.93 kU/L和212.23 ng/L，且联合检测的AUC（0.862）高于单一检测。结论 血清CA125和NT-proBNP联合检测在HFpEF诊断、疗效判断及预后评估中均具有较高应用价值。

• Objective To explore the evaluation of carbohydrate antigen 125 (CA125) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in diagnosis, efficacy judgment and prognosis of heart failure with preserved ejection fraction (HFpEF). Methods The clinical data of 124 patients with HFpEF (HFpEF group) and 98 patients with diastolic dysfunction (diastolic dysfunction group) in the No.2 Hospital of Baoding from February 2017 to January 2019 were retrospectively analyzed, and 48 people who were admitted to the hospital for physical examination during the same period were included as healthy control group. The differences in serum CA125 and NT-proBNP were compared among the three groups, and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of serum CA125, NT-proBNP and their combined detection in HFpEF. The changes of serum CA125 and NT-proBNP levels in HFpEF patients with different efficacy of after treatment were analyzed. According to the occurrence of clinical endpoint events within 1 year of HFpEF patients, they were divided into non-clinical endpoint event group (good prognosis group) and clinical endpoint event group (poor prognosis group). The levels of serum CA125 and NT-proBNP levels at discharge were compared, and ROC curve was used to evaluate the predictive value of serum CA125, NT-proBNP and their combined detection in HFpEF. Results The levels of serum CA125 and NT-proBNP in HFpEF group were higher than those in diastolic dysfunction group and healthy control group［（23.7±8.8）kU/L vs （15.0±4.5）,（9.4±2.5）kU/L；（597±213）ng/L vs （165±52）,（112±38）ng/L］, and those in diastolic dysfunction group were higher than those in healthy control group (all P＜0.05). ROC curve analysis showed that serum CA125 and NT-proBNP had high diagnostic value in HFpEF ［the area under the curve (AUC)=0.854, 0.979, both P＜0.05］, and the cut-off values were 19.28 kU/L and 286.27 ng/L respectively. The AUC(0.987) of combined detection was higher than that of single detection. After 1 month of treatment, there were 44 markedly effective cases, 56 effective cases and 24 ineffective cases among 124 HFpEF patients. After treatment, the levels of serum CA125 and NT-proBNP in markedly effective cases were lower than those in effective cases and ineffective cases, and those in effective cases were lower than those in ineffective cases (all P＜0.05). Within 1 year of discharge, 23 cases (18.55%) had clinical end point events and were included in poor prognosis group; 101 patients (81.5%) had no clinical endpoint events and were included in good prognosis group. The levels of serum CA125 and NT-proBNP in poor prognosis group at discharge were higher than those in good prognosis group (both P＜0.05). ROC curve showed that serum CA125 and NT-proBNP at discharge had high predictive value in HFpEF prognosis (AUC=0.752, 0.840, both P＜0.05), and their cut-off values were 14.93 kU/L and 212.23 ng/L. The AUC(0.862) of the combined detection was higher than that of the single detection. Conclusion Serum CA125 combined with NT-proBNP has high application value in HFpEF diagnosis, efficacy judgment and prognosis prediction.