2025 年第 2 期 第 20 卷

泛免疫炎症值与老年慢性心力衰竭患者左心室重构及不良预后的相关性研究

Study on the correlation between pan-immune inflammation value and left ventricular remodeling and poor prognosis in elderly patients with chronic heart failure

作者：裴淑娟1刘芳1管丽红2王强3万琴1陈功财1

英文作者：Pei Shujuan1 Liu Fang1 Guan Lihong2 Wang Qiang3 Wan Qin1 Chen Gongcai1

单位：1中国人民解放军联勤保障部队第九〇八医院干部病房，南昌330002；2中国人民解放军联勤保障部队第九〇八医院体检科，南昌330002；3中国人民解放军联勤保障部队第九〇八医院心内科，南昌330002

英文单位：1Department of Geriatrics the 908th Hospital of the Joint Logistics Support Force of the People′s Liberation Army of China Nanchang 330002 China; 2Department of Medical Examination the 908th Hospital of the Joint Logistics Support Force of the People′s Liberation Army of China Nanchang 330002 China; 3Department of Cardiology the 908th Hospital of the Joint Logistics Support Force of the People′s Liberation Army of China Nanchang 330002 China

关键词：慢性心力衰竭；泛免疫炎症值；左心室重构；不良预后

英文关键词：Chronicheartfailure;Pan-immuneinflammationvalue;Leftventricularremodeling;Poorprognosis

• 摘要：

• 目的 探讨泛免疫炎症值(PIIV)与老年慢性心力衰竭患者左心室重构及不良预后的相关性。方法 本研究为回顾性分析。收集中国人民解放军联勤保障部队第九〇八医院2020年1月至2021年12月收治的老年慢性心力衰竭患者150例作为慢性心力衰竭组。另收集同期于本院进行体检的150例相对健康老年志愿者为对照组。慢性心力衰竭组再依据PIIV高低分为亚组。比较不同组间临床资料差异，同时分析PIIV与心室重构相关指标的相关性及其预测老年慢性心力衰竭患者左心室重构的效能，同时分析老年慢性心力衰竭患者左心室重构相关因素。结果 慢性心力衰竭组患者PIIV显著高于对照组 ［687.4(472.1, 856.9)比305.1(185.4, 440.6)］，差异有统计学意义(P＜0.05)。根据慢性心力衰竭组PIIV的中位数将慢性心力衰竭组患者分为低PIIV组（PIIV≤687.4，75例）和高PIIV组（PIIV＞687.4，75例）。高PIIV组患者的左心室重构发生率、左心室收缩末期容积（LVESV）和左心室舒张末期容积（LVEDV）高于/大于低PIIV组，而左心室射血分数（LVEF）低于低PIIV组［61.3%（46/75）比41.3%（31/75）、（198±17）ml比（186±12）ml、（230±15）ml比（219±14）ml、（42±11）%比（47±8）%］，差异均有统计学意义(均P＜0.05)。高PIIV组患者的再发心力衰竭和心源性再住院率高于低PIIV组［54.7%（41/75）比33.3%（25/75）、41.3%（31/75）比22.7%（17/75）］，差异均有统计学意义(均P<0.05)。PIIV与LVESV和LVEDV呈明显正相关(r=0.502、0.542，均P＜0.001)，与LVEF呈明显负相关(r=-0.533，P＜0.001)。PIIV预测老年慢性心力衰竭患者左心室重构的受试者工作特征曲线下面积为0.869，95%置信区间：0.822～0.916。多因素COX回归分析结果显示PIIV、纽约心脏病协会心功能分级和N末端B型脑钠肽前体均为慢性心力衰竭组患者左心室重构的影响因素(均P＜0.05)。结论 PIIV在评估老年慢性心力衰竭患者左心室重构方面具有良好的预测价值。

• Objective To investigate the correlation between pan-immune inflammation value (PIIV) and left ventricular remodeling and poor prognosis in elderly patients with chronic heart failure. Methods This study was a retrospective analysis. A total of 150 elderly patients with chronic heart failure admitted to the 908th Hospital of the Joint Logistics Support Force of the People′s Liberation Army of China from January 2020 to December 2021 were collected as the chronic heart failure group. In addition, 150 relatively healthy elderly volunteers who underwent physical examination in our hospital during the same period were collected as the control group. The chronic heart failure group was further divided into subgroups according to the level of PIIV. The differences in clinical data between the different groups were compared, and the correlation between PIIV and related indicators of ventricular remodeling and its efficacy in predicting left ventricular remodeling in elderly patients with chronic heart failure were analyzed. At the same time, the related factors of left ventricular remodeling in elderly patients with chronic heart failure were analyzed. Results The PIIV of patients in the chronic heart failure group was significantly higher than that in the control group ［687.4(472.1, 856.9) vs 305.1(185.4, 440.6)］(P<0.05). According to the median of PIIV in the chronic heart failure group, the patients in the chronic heart failure group were divided into low PIIV group (PIIV≤687.4, n=75) and high PIIV group (PIIV>687.4, n=75). The incidence of left ventricular remodeling, left ventricular end-systolic volume (LVESV) and left ventricular end-diastolic volume (LVEDV) in the high PIIV group were higher/greater than those in the low PIIV group, and left ventricular ejection fraction (LVEF) in the high PIIV group was lower than that in the low PIIV group ［61.3%(46/75) vs 41.3%(31/75), (198±17)ml vs (186±12)ml, (230±15)ml vs (219±14)ml, (42±11)% vs (47±8)%］(all P<0.05). The rates of recurrent heart failure and cardiac rehospitalization in the high PIIV group were higher than those in the low PIIV group ［54.7%(41/75) vs 33.3%(25/75), 41.3%(31/75) vs 22.7%(17/75)］(both P<0.05). PIIV was significantly positively correlated with LVESV and LVEDV (r=0.502, 0.542, both P<0.001), and negatively correlated with LVEF (r=-0.533, P<0.001). The area under the receiver operating characteristic curve of PIIV for predicting left ventricular remodeling in elderly patients with chronic heart failure was 0.869, with a 95% confidence interval of 0.822-0.916. Multivariate COX regression analysis showed that PIIV, New York Heart Association functional class and N-terminal pro-brain natriuretic peptide were the influencing factors of left ventricular remodeling in patients with chronic heart failure (all P<0.05). Conclusion PIIV has a good predictive value for left ventricular remodeling in elderly patients with chronic heart failure.