QRS波群时限联合血清angptl2、angptl7、sST2对急性心力衰竭患者短期预后的评估价值

doi:10.11958/20230053

摘要/Abstract

摘要：

目的探讨急性心力衰竭（AHF）患者QRS波群时限联合血清血管生成素样蛋白（angptl）2、angptl7、可溶性致癌抑制因子2（sST2）对预后的预测价值。方法收集AHF患者104例为病例组，记录其基线资料，根据美国纽约心脏病协会（NYHA）分级将患者分为Ⅱ级组、Ⅲ级组和Ⅳ级组，根据预后情况分为预后良好组和预后不良组；收集本院同期98例健康体检者作为对照组。心电图机测量QRS波群时限；酶联免疫吸附试验检测血清angptl2、angptl7、sST2水平；采用受试者工作特征（ROC）曲线分析QRS波群时限联合血清angptl2、angptl7、sST2水平对AHF患者预后的预测价值；采用多因素Cox回归分析预后不良的影响因素。结果病例组QRS波群时限及血清angptl2、angptl7、sST2水平高于对照组（P<0.05）。Ⅱ级组、Ⅲ级组、Ⅳ级组QRS波群时限及血清angptl2、angptl7、sST2水平依次升高（P<0.05）。预后不良组NYHA分级、左心室舒张末期内径（LVEDD）、QRS波群时限及血清angptl2、angptl7、sST2水平高于预后良好组，左心室射血分数（LVEF）低于预后良好组（P<0.05）。QRS波群时限，血清angptl2、angptl7、sST2及联合预测AHF患者预后不良的AUC分别为0.773、0.767、0.833、0.743、0.907。高NYHA分级和高sST2是AHF患者预后不良的独立危险因素（P<0.05）。结论 AHF患者QRS波群时限，血清angptl2、angptl7、sST2水平随患者病情加重而升高，NYHA分级、sST2是AHF患者短期预后不良的独立影响因素。

关键词: 心力衰竭, 急性病, 血管生成素样蛋白质类, 预后, QRS波群时限, 可溶性致癌抑制因子2

Abstract:

Objective To investigate the prognostic value of QRS complex duration combined with serum angiopoietin-like protein (angptl)2, angptl7 and soluble tumor suppressor factor 2 (sST2) in patients with acute heart failure (AHF). Methods A total of 104 patients with AHF were collected as the case group, and their baseline data were recorded. According to the American New York Heart Association (NYHA) classification, patients were divided into the class Ⅱ group, the class Ⅲ group and the class Ⅳ group. According to the prognosis, patients were grouped into the good prognosis group and the poor prognosis group, and 98 healthy subjects in our hospital were collected as the control group. The QRS complex time limit was measured by electrocardiograph, and serum levels of angptl2, angptl7 and sST2 were detected by enzyme-linked immunosorbent assay. Receiver operating characteristic (ROC) curve was applied to analyze the predictive value of QRS complex duration combined with serum angptl2, angptl7 and sST2 levels on the prognosis of patients with AHF. Multivariate Cox regression was used to analyze influencing factors of poor prognosis in patients with AHF. Results The QRS complex time limit and serum levels of angptl2, angptl7 and sST2 were higher in the case group than those in the control group (P<0.05). The QRS complex time limit and serum levels of angptl2, angptl7 and sST2 in the grade Ⅱ group, the grade Ⅲ group and the grade Ⅳ group were increased in turn (P<0.05). The NYHA classification, left ventricular end diastolic dimension (LVEDD), QRS complex time limit and serum levels of angptl2, angptl7 and sST2 were greatly higher in the poor prognosis group than those in the good prognosis group, and the left ventricular ejection fraction (LVEF) was greatly lower in the poor prognosis group than that in the good prognosis group (P<0.05). The AUC of QRS complex time limit, serum angptl2, angptl7, sST2 and the combined prediction of poor prognosis in patients with AHF were 0.773, 0.767, 0.833, 0.743 and 0.907, respectivily. High NYHA class and high sST2 were independent risk factors for poor prognosis in patients with AHF (P<0.05). Conclusion The QRS complex duration, serum levels of angptl2, angptl7 and sST2 in AHF patients increase with the worsening of the disease. NYHA grading and sST2 are independent factors for poor short-term prognosis in AHF patients.

Key words: heart failure, acute disease, angiopoietin-like proteins, prognosis, QRS complex duration, sST2

中图分类号:

R541.6，R445.1

图/表 8

参考文献 15

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组别	n	QRS波群时限/ms	angptl2/（μg/L）	angptl7/（ng/L）	sST2/（mg/L）
对照组	98	86.42±17.94	1.82±0.39	172.43±25.61	89.36±15.71
病例组	104	130.46±25.79	4.62±1.45	696.45±87.63	209.48±60.22
t		14.002^＊＊	18.494^＊＊	56.944^＊＊	19.140^＊＊

组别	n	QRS波群时限/ms	angptl2/（μg/L）	angptl7/（ng/L）	sST2/（mg/L）
对照组	98	86.42±17.94	1.82±0.39	172.43±25.61	89.36±15.71
病例组	104	130.46±25.79	4.62±1.45	696.45±87.63	209.48±60.22
t		14.002^＊＊	18.494^＊＊	56.944^＊＊	19.140^＊＊

组别	n	QRS波群时限/ms	angptl2/（μg/L）	angptl7/（ng/L）	sST2/（mg/L）
Ⅱ级组	39	119.75±15.32	3.82±1.28	645.84±67.16	180.36±30.79
Ⅲ级组	44	132.18±23.45^a	4.65±1.42^a	704.26±86.15^a	210.45±43.28^a
Ⅳ级组	21	146.75±30.36^ab	6.04±1.67^ab	774.08±92.49^ab	261.38±56.42^ab
F		10.077^＊＊	16.610^＊＊	17.489^＊＊	25.127^＊＊

组别	n	QRS波群时限/ms	angptl2/（μg/L）	angptl7/（ng/L）	sST2/（mg/L）
Ⅱ级组	39	119.75±15.32	3.82±1.28	645.84±67.16	180.36±30.79
Ⅲ级组	44	132.18±23.45^a	4.65±1.42^a	704.26±86.15^a	210.45±43.28^a
Ⅳ级组	21	146.75±30.36^ab	6.04±1.67^ab	774.08±92.49^ab	261.38±56.42^ab
F		10.077^＊＊	16.610^＊＊	17.489^＊＊	25.127^＊＊

组别		n	男性		年龄/岁		BMI/（kg/m²）			吸烟史		饮酒史		高血压		糖尿病	LVEF		LVEDD/mm
预后良好组		76	39（51.3）		62.54±10.13		23.42±3.65			35（46.1）		18（23.7）		47（61.8）		20（26.3）	0.57±0.05		46.72±4.48
预后不良组		28	16（57.1）		60.17±9.85		24.01±3.59			13（46.4）		7（25.0）		19（67.9）		8（28.6）	0.39±0.04		55.94±5.12
χ²或t			0.279		1.066		0.734			0.001		0.019		0.319		0.053	17.121^＊＊		8.954^＊＊
组别	NYHA分级							服用药物					病因
组别	Ⅱ级			Ⅲ级		Ⅳ级		β受体阻滞剂	利尿剂		血管紧张素系统阻滞剂		心肌病		缺血性心脏病			肺源性心脏病		心脏瓣膜病
预后良好组	36（47.4）			34（44.7）		6（7.9）		68（89.5）	64（84.2）		62（81.6）		28（36.8）		17（22.4）			9（11.8）		22（29.0）
预后不良组	3（10.7）			10（35.7）		15（53.6）		26（92.7）	24（85.7）		24（85.7）		10（35.7）		6（21.4）			5（17.9）		7（25.0）
χ²或t	28.866^＊＊							0.270	0.036		0.244		0.680