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血清基质金属蛋白酶-9、可溶性尿激酶型纤溶酶原激活物受体及纤溶酶原激活物抑制因子-1联合检测预测老年慢性心力衰竭患者预后的价值

Value of combined detection of serum matrix metalloproteinase-9, soluble urokinase type plasmin activator receptor and plasmin activator inhibitor-1 in predicting prognosis of elderly patients with chronic heart failure

    摘要
  • 摘要:
    目的 探讨血清基质金属蛋白酶-9(MMP-9)、可溶性尿激酶型纤溶酶原激活物受体(suPAR)及纤溶酶原激活物抑制因子-1(PAI-1)表达与老年慢性心力衰竭(CHF)患者心功能分级及预后的关系。
    方法 选取廊坊市中医医院收治的108例CHF患者及同期50例健康体检者分别作为研究组和对照组。采集受试者血液标本, 测定血清MMP-9、suPAR及PAI-1水平。比较不同纽约心脏病协会(NYHA)心功能分级患者及不同预后患者的血清指标差异，并分析各血清指标对不良预后的预测价值。
    结果 与对照组相比，研究组血清MMP-9、suPAR、PAI-1水平更高，差异有统计学意义(P < 0.05)。NYHA分级Ⅱ级、Ⅲ级、Ⅳ级CHF患者的血清MMP-9、suPAR、PAI-1水平呈逐渐升高趋势，差异均有统计学意义(P < 0.05)。随访1年的结果显示，预后良好65例，预后不良43例，预后不良率为39.81%(43/108)。与预后良好患者相比，预后不良患者的年龄更大，合并高血压率更高，左室射血分数(LVEF)更低，左室舒张末期内径(LVEDD)、MMP-9、suPAR及PAI-1水平更高，差异有统计学意义(P < 0.05)。Logistic回归分析显示，年龄、MMP-9、suPAR、PAI-1均是老年CHF患者预后不良的危险因素, LVEF是老年CHF患者预后不良的保护因素(P < 0.05)。血清MMP-9、suPAR、PAI-1单独检测及3项联合检测的曲线下面积(AUC)分别为0.711、0.829、0.768和0.840, 3项联合检测的敏感度为88.21%, 特异度为79.46%。
    结论 老年慢性CHF患者的血清MMP-9、suPAR、PAI-1表达水平与心功能分级及预后不良密切相关。

     

    Abstract:
    Objective To investigate the relationships of the expression of serum matrix metalloproteinase-9 (MMP-9), soluble urokinase type plasmin activator receptor (suPAR) and plasmin activator inhibitor-1 (PAI-1) with the cardiac function grading and prognosis in elderly patients with chronic heart failure (CHF).
    Methods A total of 108 CHF patients and 50 healthy individuals with physical examination in the same period in Langfang City Hospital of Traditional Chinese Medicine were respectively selected as study group and control group. The blood samples were collected for detection of serum levels of MMP-9, suPAR and PAI-1. The differences in serum indicators among patients with different cardiac functional grades of the New York Heart Association (NYHA) and different prognoses were compared, and the predictive values of serum indicators for poor prognosis were analyzed as well.
    Results Compared with the control group, the serum levels of MMP-9, suPAR and PAI-1 in the study group were significantly higher (P < 0.05). The levels of serum MMP-9, suPARand PAI-1 increased gradually and significantly in patients with the increase of NYHA grading as grade Ⅱ, grade Ⅲ and grade Ⅳ (P < 0.05). The results of the one-year follow-up showed that there were 65 cases with good prognosis and 43 cases with poor prognosis, and the poor prognosis rate was 39.81% (43/108). Compared with patients of good prognosis, patients with poor prognosis had higher age, higher incidence of complicated hypertension, lower left ventricular ejection fraction (LVEF), and higher levels of left ventricular end diastolic diameter (LVEDD), MMP-9, suPAR and PAI-1 (P < 0.05). Logistic regression analysis showed that age, MMP-9, suPAR and PAI-1 were the risk factors for poor prognosis in elderly patients with CHF, while LVEF was a protective factor for poor prognosis in elderly patients with CHF (P < 0.05). The area under the curve (AUC) of serum MMP-9, suPAR and PAI-1 detected separately and in combination were 0.711, 0.829, 0.768 and 0.840 respectively, the sensitivity and specificity of the three indexes in combination were 88.21% and 79.46% respectively.
    Conclusion The expression levels of serum MMP-9, suPAR and PAI-1 in elderly patients with CHF are closely related to thecardiac functional grading and poor prognosis.

     

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