[1]张丽伟a,李晓丹b,赵　赫a,等.射血分数正常心力衰竭患者Fibrosis-4指数与右心室功能及预后的相关性研究[J].现代检验医学杂志,2022,37(02):167-172.[doi:10.3969/j.issn.1671-7414.2022.02.034]
　ZHANG Li-weia,LI Xiao-danb,ZHAO Hea,et al.Correlation between Fibrosis-4 Index and Right Ventricular Function and Prognosis in Patients with Heart Failure with Preserved Ejection Fraction[J].Journal of Modern Laboratory Medicine,2022,37(02):167-172.[doi:10.3969/j.issn.1671-7414.2022.02.034]
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射血分数正常心力衰竭患者Fibrosis-4指数与右心室功能及预后的相关性研究()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第37卷
期数:
2022年02期
页码:
167-172
栏目:
检验与临床
出版日期:
2022-03-15

文章信息/Info

Title:
Correlation between Fibrosis-4 Index and Right Ventricular Function and Prognosis in Patients with Heart Failure with Preserved Ejection Fraction
文章编号:
1671-7414（2022）02-167-06
作者:
张丽伟a; 李晓丹b; 赵　赫a; 曾辰华a
（辽阳市中心医院a. 冠心病监护病房; B. 心血管内二科，辽宁辽阳 111000）
Author(s):
ZHANG Li-weia;  LI Xiao-danb;  ZHAO Hea;  ZENG Chen-huaa
（a. CCU Ward；b. the Second Department of Cardiovascular Medicine, the Central Hospital of Liaoyang City,Liaoning Liaoyang 111000，China）
关键词:
射血分数正常心力衰竭; 肝纤维化; 纤维化-4指数; 右心室功能; 主要不良心血管事件
分类号:
R541.6；R446.11
DOI:
10.3969/j.issn.1671-7414.2022.02.034
文献标志码:
A
摘要:
目的　探讨射血分数正常心力衰竭（heart failure with preserved ejection fraction，HFpEF）患者纤维化-4 指数（Fibrosis-4 index，F4I）与右心室功能及预后的相关性。方法　选取2017 年1 月~2018 年12 月辽阳市中心医院收治的116例HFpEF 患者为研究对象。采用全自动生化分析仪测定血清血肌酐（Serum creatinine，SCr），总胆红素（total bilirubin，TBil），血红蛋白（hemoglobin，Hb），天冬氨酸氨基转移酶（aspartate aminotransferase，AST）和丙氨酸氨基转移酶（alanine aminotransferase，ALT）水平，采用全自动血液分析仪测定血小板计数（platelet count，PLT），用酶联免疫吸附法测定血清N 末端脑利钠肽前体（N-terminal pro brain natriuretic peptide，NT-pro-BNP）水平。根据患者年龄，AST，ALT 和PLT计算F4I。行超声心动图检查，测定三尖瓣环状平面收缩期偏移（tricuspid annular plane systolic excursion，TAPSE）及三尖瓣环收缩期峰值速度（S’）。比较患者入院时及出院前血生化指标与心脏超声指标。采用Spearman 相关性分析出院前F4I 与TAPSE，S’ 的相关性，多元线性回归分析TAPSE，S’ 相关影响因素。对患者进行随访，统计主要不良心血管事件（major adverse cardiovascular events，MACE）发生情况，采用Cox 回归分析出院前F4I，NT-proBNP 与MACE 发生的关系，采用ROC 曲线分析出院前F4I 对HFpEF 患者MACE 发生的预测价值。结果　出院前TBil[0.61（0.40, 0.84）g/dl]，AST
[26.91（21.54, 35.26）IU/L]，ALT[18.74（10.22, 28.54）IU/L]，NT-proBNP
[2 003.41（1 037.42, 2 820.43）pg/ml]，F4I
[2.89（2.07, 3.40）] 水平显著低于入院时[0.78（0.39,1.15）g/dl, 47.47（20.88, 67.83）IU/L, 36.98（19.75，61.78）IU/L,4 905.03（2 570.65, 7 644.43）pg/ml, 3.56（2.60, 4.54）]，TAPSE[18.05（15.20，21.88）mm]，S’（14.50±5.81cm /s）显著高于入院时[17.02（14.87，18.52）mm, 11.78±2.60cm/s]，差异均有统计学意义（t/W= -2.238, -4.364, -4.735, -6.221, -4.178,-3.481, -4.694，均P ＜ 0.05）。相关性分析显示出院前F4I 与TAPSE，S’ 呈负相关（r=-0.825，-0.837，均P ＜ 0.05）。多元线性回归分析显示，F4I 可负向影响TAPSE，S’（β=-0.244，-0.266，均P ＜ 0.05）。经730 天随访，MACE 发生率为31.90%。多因素Cox 回归分析显示出院前F4I 是MACE 发生的独立风险因素（P=0.013），随F4I 增高MACE 发生增高比为1.270（95%CI：1.052~1.532）。ROC 曲线分析显示，出院前F4I 预测HFpEF 患者发生MACE 的曲线下面积为0.740，敏感度和特异度分别为72.97%，79.75%。结论　F4I 水平与HFpEF 患者的右心室功能障碍呈负相关，高F4I 的HFpEF 患者MACE 发生风险较高，F4I 可作为HFpEF 患者右心室功能评估及预后评估的指标。
Abstract:
Objective　To investigate the correlation between fibrosis-4 index (F4I) and right ventricular function and prognosis in patients with heart failure with preserved ejection fraction (HFpEF). Methods　116 HFpEF patients in Liaoyang Central Hospital from December 2017 to December 2018 were selected as the study subjects.The levels of serum creatinine (SCr), total bilirubin (TBil), hemoglobin (Hb), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured by automatic biochemical analyzer, platelet count (PLT) was measured by automatic blood analyzer,and the levels of N-terminal pro brain natriuretic peptide (NT-pro-BNP) were measured by enzyme-linked immunosorbent assay.F4i was calculated according to the patient’s age, AST, ALT and PLT.The tricuspid annular plane systolic deviation (TAPSE) and tricuspid annular systolic peak velocity (S’) was measured by echocardiography.The blood biochemical indexes and cardiac ultrasound indexes were compared at admission and before discharge.Spearman correlation was used to analyze the correlation between F4I and TAPSE, S’ before discharge , and multiple linear regression was used to analyze the related influencing factors of TAPSE and S’. The patients were followed up and the incidence of major adverse cardiovascular events (MACE) was counted.Cox regression was used to analyze the relationship between F4I,NT-proBNP and MACE before discharge, and ROC curve was used to analyze the predictive value of F4I before discharge for MACE in HFpEF patients. Results　Before discharge, the levels of TBil[0.61（0.40, 0.84）g/dl], AST
[26.91（21.54, 35.26）IU/L], ALT[18.74（10.22, 28.54）IU/L], NT-proBNP
[2 003.41（1 037.42, 2 820.43）pg/ml] and F4I
[2.89（2.07, 3.40）] were significantly lower than those at admission[0.78（0.39,1.15）g/dl, 47.47（20.88, 67.83）IU/L, 36.98 （19.75，61.78）IU/L, 4 905.03（2 570.65, 7 644.43）pg/ml, 3.56（2.60, 4.54）], and TAPSE[18.05（15.20，21.88）mm] and S’(14.50±5.81cm /s) were significantly higher than those at admission [17.02（14.87，18.52）mm, 11.78±2.60cm/s], the differences were statistically significant(t/W = -2.238, -4.364, -4.735, -6.221, -4.178, -3.481, -4.694, all P < 0.05).Correlation analysis showed that F4I before discharge was negatively correlated with TAPSE and S’(r =- 0.825, - 0.837, all P < 0.05).Multiple linear regression analysis showed that F4I could negatively affect TAPSE and S’（β= -0.244, -0.266, all P < 0.05). After 730 days follow-up, the incidence of MACE was 31.90%.Multivariate Cox regression analysis showed that F4I before discharge was an independent risk factor for mace (P = 0.013). With the increase of F4I, the increase ratio of MACE was 1.270 (95% CI: 1.052~1.532).ROC curve analysis showed that the area under the curve of F4I before discharge predicting MACE in HFpEF patients was 0.740, the sensitivity and the specificity were 72.97% and 79.75%, respectively. Conclusion　F4I level was negatively correlated with right ventricular dysfunction in patients with HFpEF. Patients with HFpEF with high F4I level had a higher risk of MACE.F4I can be used as an index for the evaluation of right ventricular function and prognosis in patients with HFpEF.

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备注/Memo

备注/Memo:
基金项目：辽宁省自然科学基金项目（2019060355-037）。
作者简介：张丽伟（1980-），女，硕士研究生，副主任医师，研究方向为冠心病、心衰的诊治,E-mail: zhanglw1980@163.com。
更新日期/Last Update: 1900-01-01