慢性心功能不全患者血浆铜蓝蛋白水平改变及其临床意义
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(解放军总医院第一附属医院干部病房一科,北京 100048)

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Serum ceruloplasmin level and its clinical significance in patients with chronic heart failure
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(First Department of Cadres’ Ward, the First Affiliated Hospital, Chinese PLA General Hospital, Beijing 100048, China)

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    摘要:

    目的 探讨慢性心功能不全患者血浆铜蓝蛋白(CP)水平改变及其临床意义。方法 连续性纳入2013年1月至2014年1月于解放军总医院第一附属医院住院治疗的87例慢性心力衰竭(CHF)患者。出院随访12个月最终选取70例CHF患者,按照美国纽约心脏病学会(NYHA)心功能分级将CHF患者分为3组:NYHA Ⅱ级组30例,NYHA Ⅲ级组25例,NYHA Ⅳ级组15例。另选取20例年龄相符的心功能正常者作为对照组。记录分析入院时和出院后12个月时N末端脑钠肽前体(NT-proBNP)和CP水平,并行超声心动图检查,评价心脏结构和功能。结果 入院时CHF患者NT-proBNP和CP明显高于对照组(P<0.05)。出院后12个月CHF患者NT-proBNP水平较入院时明显下降(P<0.05),但CP水平未见明显改变(P>0.05)。通过ROC曲线分析可见,在CHF患者再入院方面,出院后12个月CP水平具有中度的预测诊断价值(AUC=0.82,P=0.03)。通过Pearson和Spearman相关性分析可见,入院时CHF患者CP和左心室收缩末期内径(LVESD)呈正相关(r=0.308,P=0.025),与左室射血分数(LVEF)呈负相关(r=-0.332,P=0.023);而NT-proBNP与LVEF呈负相关(r=-0.398,P=0.038);NT-proBNP与CP相互之间存在正相关(r=0.408,P=0.042)。但在出院后12个月时未见上述相关性。结果 CHF患者血清CP明显升高,与CHF患者再住院率相关, CP是评价和预测CHF患者临床预后的潜在生物学标志物。

    Abstract:

    Objective To determine the change of serum ceruloplasmin (CP) in the patients with chronic heart failure (CHF) and evaluate its clinical value. Methods Consecutive 70 CHF patients admitted in our hospital from January 2013 to January 2014 were enrolled in this study. According to the New York Heart Association (NYHA) cardiac function classification, they were divided into NYHA Ⅱ group (n=30), NYHA Ⅲ group (n=25), and NYHA Ⅳ group (n=15). Another 20 age-matched volunteers with normal cardiac function served as controls. The levels of CP and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured at admission and 12 months after hospital discharge. Echocardiography was performed to evaluate the cardiac structure and function. Results The levels of NT-proBNP and CP were significantly higher in the CHF group than the control group (P<0.05) at admission. In the CHF group, the NT-proBNP level was decreased in 12 months after discharge compared to that at admission (P<0.05), but no such change was observed in the CP level (P>0.05). Receiver operation characteristic (ROC) curve analysis revealed that the CP level at 12 months after discharge was of predictive diagnostic value for re-hospitalization in the patients (AUC=0.82, P=0.03). Pearson and Spearman correlation analysis showed that the CP level at admission was positively correlated with left ventricular end systolic diameter (LVESD; r=0.308, P=0.025), and negatively with left ventricular ejection fraction (LVEF, r=0.332, P=0.023) in the CHF patients. And the NT-proBNP level was negatively correlated with LVEF (r=-0.398, P=0.038), and positively with CP level (r=0.408, P=0.042). But no such correlations were found in 12 months after discharge. Conclusion The serum CP level is obviously elevated in the CHF patients, and correlated with re-hospitalization. CP can be regarded as a potential biomarker for evaluation and prognostic prediction in the patients.

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陈海威,张津津,李娜,王磊,翟红霞,夏云峰.慢性心功能不全患者血浆铜蓝蛋白水平改变及其临床意义[J].中华老年多器官疾病杂志,2017,16(1):33~37

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  • 收稿日期:2016-08-22
  • 最后修改日期:2016-11-06
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  • 在线发布日期: 2017-01-18
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