2022 年第 11 期 第 17 卷

血浆肿瘤坏死因子α刺激基因6蛋白及左心室球形指数与老年扩张型心肌病患者主要不良心血管事件的关系

Association of plasma tumor necrosis factor alpha-stimulated gene 6 protein and left ventricular sphericity index with major adverse cardiovascular events in elderly patients with dilated cardiomyopathy

作者：林德文梁荣珍陈宏丹王灵纳殷雪娇林莉

英文作者：Lin Dewen Liang Rongzhen Chen Hongdan Wang Lingna Yin Xuejiao Lin Li

单位：海南医学院第二附属医院老年医学科，海口570311

英文单位：Department of Geriatrics the Second Affiliated Hospital of Hainan Medical University Haikou 570311 China

关键词：扩张型心肌病；肿瘤坏死因子α刺激基因6蛋白；左心室球形指数；主要不良心血管事件

英文关键词：Dilatedcardiomyopathy;Tumornecrosisfactoralpha-stimulatedgene6protein;Leftventricularsphericityindex;Majoradversecardiovascularevents

• 摘要：

• 目的 探讨血浆肿瘤坏死因子α刺激基因6（TSG-6）蛋白及左心室球形指数（LVSI）与老年扩张型心肌病（DCM）患者主要不良心血管事件（MACE）的关系。方法 选取2020年1月至2022年1月海南医学院第二附属医院收治的135例老年DCM患者（DCM组），根据是否发生MACE分为MACE组(32例)和无MACE组(103例)，另选取同期53名体检健康老年人为对照组。采用酶联免疫吸附试验法检测2组血浆TSG-6蛋白水平，超声心动图检查记录LVSI。采用多因素Logistic回归方法分析老年DCM患者发生MACE的影响因素，受试者工作特征（ROC）曲线分析血浆TSG-6蛋白和LVSI对老年DCM患者发生MACE的预测价值。结果 DCM组血浆TSG-6蛋白水平和LVSI均高于对照组（均P＜0.05）。多因素Logistic回归分析结果显示，左心室射血分数（比值比＝0.810，95%置信区间：0.716～0.917）、左心室短轴缩短率（比值比＝0.801，95%置信区间：0.659～0.974）为老年DCM患者发生MACE的独立保护因素，N末端B型脑钠肽前体（比值比＝1.031，95%置信区间：1.018～1.044）、TSG-6蛋白（比值比＝1.043，95%置信区间：1.020～1.066）、LVSI（比值比＝1.445，95%置信区间：1.182～1.768）为独立危险因素（均P＜0.05）。ROC曲线分析结果显示，血浆TSG-6蛋白、LVSI单独与联合预测老年DCM患者发生MACE的曲线下面积（AUC）分别为0.836、0.816、0.917，敏感度分别为75.00%、84.37%、90.62%，特异度分别为84.47%、66.02%、80.58%。血浆TSG-6蛋白联合LVSI预测老年DCM患者发生MACE的AUC大于二者单独评估（均P＜0.05）。结论 老年DCM患者血浆TSG-6蛋白、LVSI升高，是患者发生MACE的独立危险因素，二者联合对患者发生MACE的预测价值较高。

• Objective To investigate the association of plasma tumor necrosis factor alpha-stimulated gene 6 (TSG-6) protein and left ventricular sphericity index (LVSI) with major adverse cardiovascular events (MACE) in elderly patients with dilated cardiomyopathy (DCM). Methods Totally 135 elderly patients with DCM admitted to the Second Affiliated Hospital of Hainan Medical University from January 2020 to January 2022 (DCM group) were selected. According to the occurrence of MACE, patients were divided into MACE group (32 cases) and non-MACE group (103 cases). Another 53 healthy elderly people with physical examination were selected as the control group. Plasma TSG-6 protein level was measured by enzyme-linked immunosorbent assay and LVSI was recorded by echocardiography. Multivariate Logistic regression analysis was used to analyze the factors influencing MACE in elderly patients with DCM, and the value of plasma TSG-6 protein and LVSI in assessing MACE in elderly patients with DCM was analyzed using receiver operating characteristic (ROC) curve. Results Plasma TSG-6 protein level and LVSI were higher in the DCM group than those in the control group (both P＜0.05). Multivariate Logistic regression analysis showed that left ventricular ejection fraction ［odds ratio (OR)=0.810, 95% confidence interval(CI): 0.716-0.917］, left ventricular fractional shortening (OR=0.801, 95% CI:0.659-0.974) were independent protective factors for MACE in elderly DCM patients, and N-terminal pro-brain natriuretic peptide precursors (OR=1.031, 95% CI:1.018-1.044), TSG-6 protein (OR=1.043, 95% CI:1.020-1.066) and LVSI (OR=1.445, 95% CI:1.182-1.768) were independent risk factors (all P＜0.05). ROC curve analysis showed that the area under the curve (AUC) of plasma TSG-6 protein and LVSI alone and in combination to assess MACE in elderly patients with DCM were 0.836, 0.816 and 0.917, with sensitivities of 75.00%, 84.37% and 90.62% and specificities of 84.47%, 66.02% and 80.58%, respectively. The AUC of plasma TSG-6 protein combined with LVSI for assessing MACE in elderly patients with DCM was greater than the two alone (both P＜0.05). Conclusion Elevated plasma TSG-6 protein and LVSI in elderly patients with DCM are independent risk factors for MACE, and the combination of the two indicators is of high value in the assessment of MACE in patients.