[1]马 聪,徐志伟,高彦琳,等.射血分数保留型心力衰竭患者血浆纤维蛋白原水平与易损期预后的预测价值研究[J].现代检验医学杂志,2023,38(04):180-185+200.[doi:10.3969/j.issn.1671-7414.2023.04.033]
　MA Cong,XU Zhiwei,GAO Yanlin,et al.Study on the Predictive Value of Plasma Fibrinogen Level and Vulnerable Stage Prognosis in Patients with Ejection Fraction Preserving Heart Failure[J].Journal of Modern Laboratory Medicine,2023,38(04):180-185+200.[doi:10.3969/j.issn.1671-7414.2023.04.033]
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射血分数保留型心力衰竭患者血浆纤维蛋白原水平与易损期预后的预测价值研究()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第38卷
期数:
2023年04期
页码:
180-185+200
栏目:
检验与临床
出版日期:
2023-07-15

文章信息/Info

Title:
Study on the Predictive Value of Plasma Fibrinogen Level and Vulnerable Stage Prognosis in Patients with Ejection Fraction Preserving Heart Failure
文章编号:
1671-7414（2023）04-180-07
作者:
马 聪; 徐志伟; 高彦琳; 成 威
（安徽省第二人民医院心血管内科，合肥 230000）
Author(s):
MA Cong;  XU Zhiwei;  GAO Yanlin;  CHENG Wei
（Department of Cardiovascular Medicine, the Second People’s Hospital of Anhui Province, Hefei 230000, China）
关键词:
射血分数保留型心力衰竭; 易损期; 纤维蛋白原
分类号:
R541.6；R446.11
DOI:
10.3969/j.issn.1671-7414.2023.04.033
文献标志码:
A
摘要:
目的　探讨血浆纤维蛋白原（fibrinogen，FIB）水平对射血分数保留型心力衰竭（heart failure with preservedejection fraction，HFpEF）患者易损期预后的预测价值研究。方法　前瞻性研究，选取2019 年2 月～ 2022 年3 月于安徽省第二人民医院诊治的HFpEF 患者102 例为研究对象。记录患者的一般临床资料、超声心动图、实验室指标及治疗方法。使用受试者工作特征（receiver operating characteristic，ROC）曲线评价FIB 对HFpEF 患者易损期复合终点预测的最佳临界值，并据此分为A 组（n=52）和B 组（n=50），比较二组的一般资料及实验室指标。使用Pearson 相关性分析FIB 与各指标的相关性。采用Kaplan-Meier 法和LOG-rank 检验分析FIB 水平对患者复合终点事件发生风险的影响。筛选影响患者预后情况的指标，将FIB 纳入和剔除分别构建HFpEF 患者易损期预后的预测模型，并对模型进行评价。结果　血浆FIB 检测HFpEF 患者易损期终点事件的ROC 曲线下面积area under the curve（AUC）为0.876，敏感度和特异度分别为86.9%，78.3%，最佳分界值为3.19 g/L。血红蛋白、清蛋白与FIB 水平呈明显负相关（r =-0.831，-0.805，均P<0.05）；空腹血糖、低密度脂蛋白- 胆固醇（low density lipoprotein cholesterin，LDL-C）、血肌酐、N 段B 型钠尿肽前体（N-segment B-type natriuretic peptide precursor，NT-proBNP）、心肌肌钙蛋白Ｉ（cardiac troporlin I，cTnI）及肌酸激酶（creatine kinase，CK）与FIB 水平呈明显正相关（r = 0.784，0.732，0.752，0.759，0.861，0.883，均P<0.05）。生存曲线结果显示，FIB 水平与易损期内复合终点事件、因心力衰竭再住院风险有明显相关性（Log-Rank χ2=5.016，6.151，均P<0.05）。NYHA 分级Ⅲ～Ⅳ，NT-proBNP，cTnI，CK 和FIB 是影响HFpEF 患者易损期预后不良的危险因素（均P<0.05），血红蛋白、清蛋白是保护因素（均P<0.05）。结论　FIB 与血红蛋白、清蛋白呈明显负相关；与空腹血糖、LDL-C，血肌酐、NT-proBNP，cTnI 及CK 呈明显正相关。FIB 是HFpEF 患者易损期预后不良的独立预测因子。
Abstract:
Objective　To investigate the predictive value of plasma fibrinogen (FIB) level and vulnerable stage prognosis in patients with heart failure patients with preserved ejection fraction (HFpEF). Methods　A prospective study was conducted on 102 patients with HFpEF who were diagnosed and treated in the Second People’s Hospital of Anhui Province from February 2019 to March 2022. The general clinical data, laboratory indexes, echocardiography and treatment were recorded. The receiver operating characteristic (ROC) curve was used to evaluate the optimal cut-off value of FIB for predicting the composite endpoint of HFpEF patients, and the patients were divided into group A (n=52) and group B (n=50). The general data and laboratory indicators of the two groups were compared. Pearson correlation was used to analyze the correlation between FIB and each index. Kaplan- Meier method and LOG-rank test were used to analyze the effect of FIB level on the risk of compound endpoint events. The indicators affecting the prognosis of patients were screened, and the prediction models of the prognosis of HFpEF patients in the vulnerable period were constructed by including or excluding FIB, and the models were evaluated. Results　The AUC of plasma FIB in patients with HFpEF was 0.876, and the specificity and sensitivity were 78.3%，86.9%，respectively. The best cut-off value was 3.19g/L. Albumin and hemoglobin were negatively correlated with FIB (r = -0.831, -0.805, all P<0.05), while fasting blood glucose, low density lipoprotein cholesterin (LDL-C), serum creatinine，N-segment B-type natriuretic peptide precursor (NT-proBNP), cardiac troporlin I (cTnI) and creatine kinase (CK) were positively correlated with FIB (r = 0.784, 0.732,0.752, 0.759, 0.861, 0.883, all P<0.05). The results of survival curve showed that the level of FIB was significantly correlated with compound end point events during the vulnerable period and the risk of rehospitalization due to heart failure (Log-Rank χ2=5.016, 6.151, all P<0.05). NYHA grade Ⅲ ~ Ⅳ , CK, NT-proBNP，cTnI and FIB were risk factors for poor prognosis of HFpEF patients in vulnerable period (all P<0.05), while hemoglobin and albumin were protective factors (all P<0.05). Conclusion　FIB was negatively correlated with hemoglobin and albumin, while positively correlated with fasting blood glucose, LDL-C, serum creatinine, NT-proBNP，cTnI and CK. FIB is an independent predictor of poor prognosis in vulnerable stage of HFpEF patients.

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备注/Memo

备注/Memo:
基金项目：安徽医科大学校基金资助项目（2021xkj117）：lncRNA NORAD/miR-590-3p/VEGF-A 调控间充质干细胞血管生成的研究。
作者简介：马聪 ( 1990- )，女，硕士，主治医师，研究方向：心力衰竭、心脏危重症等，E-mail：619662660@qq.com。
通讯作者：成威 ( 1973- )，男，博士，主任医师，研究方向：心血管介入、起搏电生理方向等。
更新日期/Last Update: 2023-07-15