目的 分析慢性心力衰竭(CHF)患者血浆组织型金属蛋白酶抑制剂-4(TIMP-4)、可溶性E选择素(s ES)水平的变化及临床意义.方法 选择2015年5月至2017年5月于东莞台心医院收治的CHF住院患者185例作为研究组(CHF组),根据纽约心功能(NYHA)分级进一步将CHF组分为心功能Ⅰ级组(n=30),心功能Ⅱ级组(n=59),心功能Ⅲ级组(n=63),心功能Ⅳ级组(n=33).同期健康体检者50例作为对照组.对比各组血浆TIMP-4、s ES、B型脑钠肽(BNP)以及左室射血分数(LVEF)水平.分析TIMP-4与s ES水平与BNP及LVEF水平的相关性,以及TIMP-4、s ES对慢性心力衰竭患者的预测诊断效能.结果 CHF组患者血浆TIMP-4、LVEF水平显著低于对照组,其水平随着心功能分级的增加而显著下降;CHF组患者血浆s ES、BNP水平显著高于对照组,其水平随着心功能分级的增加而显著升高,差异具有统计学意义(P＜0.05).Pearson相关系数显示,CHF患者血浆TIMP-4与BNP呈负相关(r=-0.743),与LVEF呈正相关(r=0.651);s ES水平与BNP呈正相关(r=0.757),与LVEF呈负相关(Rs=-0.598).TIMP-4、s ES、BNP 诊断CHF的ROC曲线下面积分别为 0.918、0.732、0.895.三者联合诊断价值(AUC=0.985)显著高于单独BNP(AUC=0.895),特异性为89.9%,敏感度为95.3%.结论 TIMP-4与s ES能有效反映CHF患者的病情程度,对CHF患者的诊断及病情评估具有较高的临床应用价值.
To analyze the changes and clinical significance of levels of plasma tissue inhibitor of metalloproteinase-4 (TIMP-4) and soluble E-selectin (s ES) in patients with chronic heart failure (CHF). Methods CHF patients (n=185) were chosen (CHF group) from Dongguan Taixin Hospital from May 2015 to May 2017. The CHF group was further divided, according to NYHA classification of heart function, into group I (n=30), group II (n=59), group III (n=63) and group IV (n=33). At the same time the healthy controls (n=50) were chosen into control group. The levels of plasma TIMP-4 and s ES, B-type natriuretic peptide (BNP) and left ventricular ejection fraction (LVEF) were compared among all groups. The correlation among TIMP-4 and s ES, BNP and LVEF, and predictive value of TIMP-4 and s ES to CHF diagnosis were analyzed. Results The levels of TIMP-4 and LVEF were significantly lower in CHF group than those in control group, and they decreased significantly along with the increase of NYHA classification of heart function. The levels of s ES and BN were significantly higher in CHF group than those in control group, and they increased significantly along with the increase of NYHA classification of heart function (P<0.05). The results of Pearson correlation coefficient analysis showed that TIMP-4 was negatively correlated to BNP (r=-0.743) and positively correlated to LVEF (r=0.651) in CHF patients. The level of s ES was positively correlated to BNP (r=0.757) and negatively correlated to LVEF (Rs=-0.598). The area under curve (AUC) of receiver operating characteristic (ROC) curve of TIMP-4 was 0.918, that of s ES was 0.732 and that of BNP was 0.895 in CHF diagnosis. The diagnostic value of TIMP-4, s ES and BNP combination (AUC=0.985) was significantly higher than that of BNP alone (AUC=0.895), and specificity was 89.9% and sensitivity was 95.3%. Conclusion TIMP-4 and s ES can effectively reflect the severity of CHF in CHF patients with higher clinical value to the diagnosis and severity review of CHF.