Value of endoplasmic reticulum stress markers in predicting multiple organ failure after senile heart failure
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摘要:
目的 研究内质网应激标志物预测老年心衰后多器官功能衰竭（MOF）的价值。 方法 选择2019年3月～2021年3月空军军医大学西京医院收治的126例老年心衰患者为研究对象，根据患者入院后30 d是否发生MOF将其分为MOF组（21例）和非MOF组（105例）。收集所有患者的临床资料，包括年龄、性别、身体质量指数（BMI）、美国纽约心脏病协会（NYHA）分级、合并症（高血压、冠心病、糖尿病、慢性肾衰、慢性阻塞性肺疾病、肺炎），比较两组血红蛋白（Hb）、肌钙蛋白I（TnI）、氨基末端脑钠肽前体（NT-proBNP）、葡萄糖调节蛋白78（GRP78）水平。采取非条件Logistic逐步回归分析老年心衰后发生MOF的危险因素，以ROC曲线分析GRP78、NT-proBNP预测老年心衰后发生MOF的价值，以一致性分析GRP78联合NT-proBNP预测老年心衰后发生MOF的价值。 结果 与非MOF组相比，MOF组年龄≥70岁（P<0.01）、合并慢性肾衰（P<0.05）、合并肺炎（P<0.05）的患者比例较高；MOF组GRP78（P<0.05）、NT-proBNP（P<0.01）水平较高；Logistic回归性分析显示，年龄≥70岁、合并慢性肾衰、合并肺炎、GRP78水平<393.609 ng/mL和NT-proBNP水平≥3879.394 pg/mL是老年心衰后发生MOF的危险因素；经ROC分析，GRP78≥393.609 ng/mL、NT-proBNP≥3879.394 pg/mL是老年心衰后发生MOF的最佳截断值（P<0.01），GRP78联合NT-proBNP预测老年心衰后发生MOF的曲线下面积为0.982，特异度为0.933，高于单一检测，灵敏度为0.857，与NT-proBNP相同但高于GRP78。 结论 内质网应激标志物中GRP78用于预测老年心衰后发生MOF有较高的价值，GRP78与NT-proBNP联合预测时，有利于提高预测的灵敏度与特异度。 Abstract:AIM To study the value of endoplasmic reticulum stress markers in predicting multiple organ failure (MOF) after senile heart failure. METHODS A total of 126 elderly patients with heart failure admitted to our hospital from March 2019 to March 2021 were selected as study subjects. They were divided into MOF group (21 cases) and non-MOF group (105 cases) according to the occurrence of MOF within thirty days after admission. Clinical data of all patients were collected, including age, gender, BMI, NYHA classification and comorbidities (hypertension, coronary heart disease, diabetes, chronic renal failure, chronic obstructive pulmonary disease, pneumonia). The levels of hemoglobin (Hb), troponin I (TnI), N-terminal pro-B type natriuretic peptide (NT-proBNP) and glucose regulatory protein 78 (GRP78) were compared between the two groups. The risk factors of MOF after senile heart failure were analyzed by non-conditional Logistic regression, the value of GRP78 and NT-proBNP in predicting MOF after senile heart failure was analyzed by ROC curve, and the value of GRP78 combined with NT-proBNP in predicting MOF after senile heart failure was analyzed by consistency analysis. RESULTS Compared with non MOF group, MOF group had a higher proportion of patients aged ≥ 70 years (P<0.01), complicated with chronic renal failure (P<0.05) and pneumonia (P<0.05); The levels of GRP78 (P<0.05) and NT proBNP (P<0.01) were higher in MOF group; Logistic regression analysis showed that age ≥ 70 years old, chronic renal failure, pneumonia, GRP78 level < 393.609 ng/ml and NT proBNP level ≥ 3879.394 pg/ml were the risk factors of MOF after senile heart failure; ROC analysis showed that GRP78 ≥ 393.609 ng/ml and NT proBNP ≥ 3879.394 pg/ml were the best cutoff values for MOF after senile heart failure (P<0.01). The area under the curve of GRP78 combined with NT proBNP was 0.982, the specificity was 0.933, which was higher than that of single detection, and the sensitivity was 0.857, which was the same as that of NT proBNP but higher than that of GRP78. Logistic regression analysis showed that over 70 years of age, combined with chronic renal failure, pneumonia, GRP78 level <393.609 ng/mL and NT-proBNP level above 3879.394 pg/mL were risk factors for MOF after senile heart failure. CONCLUSION Among endoplasmic reticulum stress markers, GRP78 is of high value in predicting MOF after senile heart failure. The combined prediction of GRP78 and NT proBNP is helpful to improve the sensitivity and specificity of prediction. -
表 1 老年心衰后发生MOF的单因素分析
项目 非MOF组
（n=105）MOF组
（n=21）年龄 72±5 67±5b 男性 54（51） 12（57） BMI（kg/m2） 23.1±2.2 22.7±2.6 NYHA 分级 3.52±0.36 3.59±0.28 高血压 68（65） 15（71） 冠心病 71（68） 13（62） 糖尿病 36（34） 8（38） 慢性肾衰 6（6） 5（24）a 慢性阻塞性肺疾病 8（8） 2（10） 肺炎 17（16） 9（43）a Hb（g/L） 116±26 112±23 TnI（ng/L） 0.09±0.03 0.08±0.02 GRP78（ng/mL） 392±76 437±84a NT-proBNP（pg/mL） 3685±426 4262±516b 表中计数资料均为[例数（%）]。与非MOF组相比，aP<0.05，bP<0.01 
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表 2 老年心衰后发生MOF的多因素Logistic回归性分析
因素 β 标准误 Wald/χ2 P OR 95%CI 年龄≥70岁 1.439 0.499 8.322 0.004 4.215 1.586-11.202 慢性肾衰 1.260 0.468 7.249 0.007 3.527 1.409-8.829 肺炎 1.052 0.323 10.541 0.001 2.862 1.517-5.400 GRP78≥393.609 ng/mL 1.119 0.462 5.867 0.015 3.061 1.238-7.568 NT-proBNP≥3 879.394 pg/mL 0.998 0.393 6.439 0.011 2.713 1.255-5.865
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表 3 GRP78、NT-proBNP预测老年心衰后发生MOF的ROC分析
指标 曲线下面积 标准误 P 95%CI 最佳截断值 灵敏度 特异度 GRP78 0.718 0.056 0.002 0.608-0.828 393.609 ng/mL 0.619 0.610 NT-proBNP 0.977 0.015 0.000 0.947-0.989 3879.394 pg/mL 0.857 0.819 联合预测 0.982 0.005 0.000 0.741-1.993 - 0.857 0.933
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