2022 年第 5 期 第 17 卷

D-二聚体和肌酸激酶同工酶与N末端B型脑钠肽前体在老年慢性心力衰竭患者血浆中的表达及与患者预后的相关性

Expressions of D-dimer, creatine kinase isoenzyme and N-terminal pro-brain natriuretic peptide in plasma of elderly patients with chronic heart failure and their correlation with prognosis

作者：李艳艳1王旁2李飞3

英文作者：Li Yanyan1 Wang Pang2 Li Fei3

单位：1空军军医大学第一附属医院综合诊疗科，西安710032；2空军军医大学第一附属医院医务处，西安710032；3空军军医大学第一附属医院心内科，西安710032

英文单位：1Department of General Diagnosis and Treatment the First Affiliated Hospital of Air Force Medical University Xi′an 710032 China; 2Department of Medical Service the First Affiliated Hospital of Air Force Medical University Xi′an 710032 China; 3Department of Cardiology the First Affiliated Hospital of Air Force Medical University Xi′an 710032 China

关键词：慢性心力衰竭；D-二聚体；肌酸激酶同工酶；N末端B型脑钠肽前体

英文关键词：Chronicheartfailure;D-dimer;Creatinekinaseisoenzyme;N-terminalpro-brainnatriureticpeptide

• 摘要：

• 目的 分析老年慢性心力衰竭（CHF）患者血浆中D-二聚体、肌酸激酶同工酶（CK-MB）、N末端B型脑钠肽前体(NT-proBNP)的表达情况，并探讨三者与CHF患者预后的相关性。方法 选择2020年7月至2021年7月在空军军医大学第一附属医院住院的老年CHF患者180例作为CHF组，选取同期入院的老年健康体检心功能正常者65例作为对照组。比较2组血浆D-二聚体、CK-MB、NT-proBNP水平及心脏超声指标。根据６个月内随访CHF患者是否发生主要不良心血管事件（MACE），将CHF患者分为MACE组和非MACE组。采用Logistic回归方法分析MACE发生的危险因素，采用受试者工作特征（ROC）曲线评估各项指标对CHF患者发生MACE的预测价值。结果 CHF组血浆D-二聚体、CK-MB、NT-proBNP水平及左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）均高于对照组，左心室射血分数（LVEF）低于对照组（均P＜0.05）。MACE组血浆D-二聚体、CK-MB、NT-proBNP水平及LVESD、LVEDD均高于非MACE组［（1.54±0.37）mg/L比（1.07±0.32）mg/L、（7.3±1.2）μg/L比（5.7±1.5）μg/L、（466±68）pmol/L比（398±64）pmol/L、（49±7）mm比（43±7）mm、（62±6）mm比（51±10）mm］，LVEF低于非MACE组［（45±8）%比（52±7）%］（均P＜0.05）。Logistic回归分析结果显示，D-二聚体、NT-proBNP、LVEDD是老年CHF患者发生MACE的危险因素（均P＜0.05）。ROC曲线分析结果显示，D-二聚体、NT-proBNP以及LVEDD单独及联合预测老年CHF患者发生MACE的曲线下面积分别为0.838、0.776、0.810及0.889。结论  老年CHF患者血浆中D-二聚体、CK-MB、NT-proBNP水平呈高表达。D-二聚体、NT-proBNP可能是CHF患者预后不良的危险因素。

• Objective  To analyze the expressions of D-dimer, creatine kinase isoenzyme (CK-MB) and N-terminal pro-brain natriuretic peptide(NT-proBNP) in the plasma of elderly patients with chronic heart failure (CHF), and to explore the correlations between those three and the prognosis of CHF. Methods From July 2020 to July 2021, 180 elderly CHF patients admitted to the First Affiliated Hospital of Air Force Medical University were selected as CHF group, and 65 elderly healthy patients were selected as control group. The levels of plasma D-dimer, CK-MB, NT-proBNP and cardiac ultrasound indexes were compared between the two groups. CHF patients were divided into major adverse cardiovascular events (MACE) group and non MACE group according to whether they had MACE during 6-month follow-up. Logistic regression method was used to analyze the risk factors of MACE, and receiver operating characteristic (ROC) curve was used to evaluate the predictive value of various indexes for MACE in CHF patients. Results  The levels of plasma D-dimer, CK-MB, NT-proBNP, left ventricular end systolic diameter (LVESD) and left ventricular end diastolic diameter (LVEDD) in CHF group were higher than those in control group, and left ventricular ejection fraction (LVEF) in CHF group was lower than that in control group (all P＜0.05). Levels of plasma D-dimer, CK-MB, NT-proBNP, LVESD and LVEDD in MACE group were higher than those in non MACE group［（1.54±0.37）mg/L vs （1.07±0.32）mg/L, （7.3±1.2）μg/L vs （5.7±1.5）μg/L, （466±68）pmol/L vs （398±64）pmol/L, （49±7）mm vs （43±7）mm, （62±6）mm vs （51±10）mm］, and LVEF in MACE group was lower than that in non MACE group［（45±8）% vs （52±7）%］(all P＜0.05). Logistic regression analysis showed that D-dimer, NT-proBNP and LVEDD were the risk factors of MACE in elderly patients with CHF (all P＜0.05). ROC curve evaluation showed that the areas under the curve of D-dimer, NT-proBNP, LVEDD and those combination in predicting MACE in elderly patients with CHF were 0.838, 0.776, 0.810 and 0.889 respectively. Conclusions The plasma levels of D-dimer, CK-MB and NT-proBNP are highly expressed in elderly patients with CHF. D-dimer and NT-proBNP may be risk factors for poor prognosis in patients with CHF.