半乳糖凝集素-3在射血分数保留心力衰竭患者中的应用价值

 半乳糖凝集素-3在射血分数保留心力衰竭患者中的应用价值

[摘要]目的：比较射血分数保留心力衰竭（HFPEF）的患者和射血分数降低心力衰竭（HFREF）的患者血浆半乳糖凝集素-3（Gal-3）及氨基末端脑钠肽前体（NT-proBNP）的水平变化，并探讨其对心血管事件的预测价值。方法：选取慢性心力衰竭（CHF）患者164例和健康体检者33 例，并将慢性心力衰竭患者按照左室射血分数（LVEF）分为HFPEF组（85例）及HFREF组（79例），比较Gal-3及NT-proBNP的水平变化，随访并记录患者入院后1年心血管事件（全因死亡、心衰再住院）的发生情况。结果：HFPEF患者血浆Gal-3、NT-proBNP水平显著低于HFREF患者；两组中相同心功能间Gal-3水平有统计学差异，且随着NYHA分级的增加而升高；在HFPEF、HFREF组中，发生终点事件组血浆Gal-3、NT-proBNP水平均高于未发生终点事件组；经Logsitic回归分析发现（纳入因素包括NT-proBNP等），血浆Gal-3水平是上述两种心衰患者发生心血管事件的独立危险因素（HFPEF组OR：2.035，95%CI：1.295～3.199，P＜0.05；HFREF组OR：2.015，95%CI：1.433～2.834，P＜0.05）。结论：血浆Gal-3水平可作为评判HFPEF、HFREF患者病情严重程度的重要指标。血浆Gal-3水平是HFPEF、 HFREF患者发生心血管事件的独立危险因素。

[关键词] 慢性心力衰竭；半乳糖凝集素-3；氨基末端脑钠肽前体；左室射血分数；心血管事件

The value of serum Gal-3 in chronic heart failure with preserved and reduced ejection fractionAbstract Objective: To compare the changes of Gal-3 and N-terminal pro-B type natriuretic peptide (NT-proBNP) in chronic heart failure with preserved ejection fraction (HFPEF) or reduced ejection fraction (HFREF) and explore the predictive value for the occurrence of cardiovascular events. Method: 164 patients with CHF were enrolled and were divided into two groups according to left ventricular ejection fraction (LVEF) :HFPEF group (n=85) and HFREF group (n=79) in the study, moreover, 33 healthy subjects were served as control group. Plasma Gal-3 and NT-proBNP levels were compared. The patients were followed up for 1 year and the occurrence of cardiovascular events (including all cause motality, readmission for worsening HF) were recorded. Result: The levels of Gal-3 and NT-proBNP in HFPEF group patients were significantly lower than those in HFREF group patients. The difference of Gal-3 levels between the two groups with same cardiac functional class was statistically significant, and with increased cardiac function, plasma Gal-3 level was increased; In HFPEF and HFREF group, the levels of plasma Gal-3 and NT-proBNP in the end event group were higher than those in the non event group; In the adjusted analyses that included NT-proBNP, Gal-3 levels were associated with a greater cardiovascular events risk in both groups (HFPEF group OR :2.035,95%CI:1.295~3.199,P＜0.05; HFREF group OR:2.015,95%CI:1.433~2.834,P＜0.05). Conclusion: The levels of plasma Gal-3 can be regarded as important indexes for evaluating severity of illness in patients with CHF. The levels of plasma Gal-3 is an independent predictor of the occurrence of cardiovascular events.Key words chronic heart failure; Gal-3; N-terminal pro-B type natriuretic peptide;left ventricular ejection fraction; cardiovascular events慢性心力衰竭（chronic heart failure，CHF）为各种心脏疾病的严重和终末阶段，其发病率和死亡率高，严重威胁人类健康，是当今最重要的心血管疾病之一。依据左心室射血分数（LVEF），心衰可分为LVEF降低的心衰（heart failure with reduced left ventricular ejection fraction,HFREF）和LVEF保留的心衰（heart failure with preserved left ventricular ejection fraction,HFPEF）。

国外的研究资料显示，HFPEF发病率大约占慢性心力衰竭总发病率的54%，其发病率和死亡率与HFREF相似[1]。HFPEF的病理生理学机制是复杂的,目前尚无统一意见，具体的诊断标准随时间发展。心室重构在心力衰竭的发生发展病理过程中发挥重要作用。近年来，多种血浆生物学标志物被用于心力衰竭诊断、危险分层及预后评估。Gal-3因参与心肌纤维化过程[2, 3]，已被大量临床研究证实其对心衰的早期诊断和预后判断具有一定的参考价值。