血清新喋呤对射血分数保留的心力衰竭的辅助诊断意义

摘要

目的 观察射血分数保留的心力衰竭(HFpEF)患者血清新喋呤的水平,探讨血清新喋呤对HFpEF的辅助诊断意义.方法 连续入选2016年10月~2017年8月于大连大学附属中山医院心脏中心住院心功能(NYHA分级)Ⅱ~Ⅳ级HFpEF患者共90例(HEpEF组),另选取同期入院基本临床资料相匹配的非心力衰竭患者80例作为对照组(非HFpEF组).采集入选者临床资料并分析血清新喋呤与N末端脑钠肽前体(NT-proBNP)、心脏超声有关参数的相关性,采用受试者工作特征曲线(ROC)评估血清新喋呤对HFpEF的辅助诊断意义.结果 HFpEF组中血清新喋呤、NT-proBNP、肌酐水平均高于非HFpEF组(P<0.05),随着NYHA心功能分级的增加,NT-proBNP与血清新喋呤逐渐升高(P<0.05);Spearman相关性分析显示,新喋呤与NT-proBNP、 E/E'、左房内径(LAD)、室间隔厚度(IVSD)呈显著正相关,而与LVEF、LVDD未见明显相关性;血清新喋呤诊断HFpEF的ROC曲线下面积(AUC)为 0.720 (95%CI:0.600~0.830 ,P<0.05),NT-proBNP为0.928(95%CI:0.863~0.994,P<0.05),二者联合为0.932(95%CI:0.866~0.998,P<0.05).结论 HFpEF患者血清新喋呤明显增高,且与心力衰竭的严重程度相关.%Objective To observe the level of serum neopterin in patients with heart failure with ejection fraction (HFpEF), and to investigate the significance of serum neopterin in the diagnosis of HFpEF. Methods This study recruited 90 patients with HFpEF (HFpEF group) hospitalized in Cardiology center of Zhongshan Hospital Affiliated to Dalian University from October 2016 to August 2017. We divided patients into three groups according to NYHA heart function classification criterion: NYHA Class Ⅱ group (n=37), NYHA ClassⅢ group (n=34), NYHA Class Ⅳ group (n=19). In addition, 80 patients without heart failure matched with similar clinical characteristics were selected as control group (non HFpEF group). We collected the clinical data of patients and measured the plasma NT-proBNP level. The level of serum neopterin was detected by enzyme linked immunosorbent assay. The correlation between serum neopterin and NT-proBNP, the parameters of cardiac ultrasound were analyzed. The receiver operating characteristic curve (ROC) was used to evaluate the significance of serum neopterin in the diagnosis of HFpEF. Results The level of serum neopterin, NT-proBNP and creatinine in the HFpEF group were higher than those in the non HFpEF group (P<0.05). With the increase of NYHA cardiac function classification, the concentration of NT-proBNP and serum neopterin increased gradually (P<0.05). The Spearman correlation analysis showed that serum neopterin was significant positively correlated with NT-proBNP, E/E', LAD, IVSD, and was not correlated with LVEF, LVDD. The area under the ROC curves of serum neopterin diagnosis for HFpEF was 0.720 (P<0.05, 95%CI: 0.600~0.830), and NT-proBNP for HFpEF diagnosis was 0.928 for AUC (P<0.05, 95%CI: 0.863~0.994), and an AUC of 0.932 (P<0.05, 95%CI: 0.866~0.998) for combination of both biomarkers. Conclusion Serum neopterin levels were significantly higher in patients with HFpEF, and were related to the severity of heart failure. Therefore, serum neopterin may become a new biochemical marker for the diagnosis of HFpEF, and united NT-proBNP can improve the diagnostic efficacy of HFpEF.