邱清勇, 彭锦, 刘大勇. 基线HE4水平对扩张型心肌病患者药物治疗反应性的评估[J]. 心脏杂志, 2023, 35(3): 310-315. DOI: 10.12125/j.chj.202207052
    引用本文: 邱清勇, 彭锦, 刘大勇. 基线HE4水平对扩张型心肌病患者药物治疗反应性的评估[J]. 心脏杂志, 2023, 35(3): 310-315. DOI: 10.12125/j.chj.202207052
    Qing-yong QIU, Jin PENG, Da-yong LIU. Evaluation of baseline HE4 levels and drug therapy responsiveness in patients with dilated cardiomyopathy[J]. Chinese Heart Journal, 2023, 35(3): 310-315. DOI: 10.12125/j.chj.202207052
    Citation: Qing-yong QIU, Jin PENG, Da-yong LIU. Evaluation of baseline HE4 levels and drug therapy responsiveness in patients with dilated cardiomyopathy[J]. Chinese Heart Journal, 2023, 35(3): 310-315. DOI: 10.12125/j.chj.202207052

    基线HE4水平对扩张型心肌病患者药物治疗反应性的评估

    Evaluation of baseline HE4 levels and drug therapy responsiveness in patients with dilated cardiomyopathy

    • 摘要:
        目的  探讨扩张型心肌病(DCM)患者基线人附睾蛋白4(HE4)水平对药物治疗反应性的评估。
        方法  选取2018年1月~2021年12月九二八医院心血管内科收治的DCM患者106例作为研究对象,按照《中国扩张型心肌病诊断和治疗指南》进行标准化药物治疗,记录所有一般资料,采用化学发光法检测基线血清HE4水平等,3个月后 2例患者因搬迁而失访,最终104例获得随访,且64例治疗反应归为反应组,其余40例治疗无反应归为无反应组。采用多因素Logistic筛选药物治疗反应性的影响因素,绘制ROC曲线评价相关因素预测药物治疗反应性的效能,并采用限制性立方样条拟合基线血清HE4水平与药物治疗反应性。
        结果  与无反应组相比,反应组 cTnI降低(P<0.01),NT-proBNP降低(P<0.01)、HE4水平降低(P<0.05)、LVEDD降低(P<0.01),差异具有统计学意义;其余项目对比差异无统计学意义;多因素Logistic回归分析显示,基线血清NT-proBNP(OR=1.002,95%CI:1.001~1.003,P<0.01)、HE4(OR=1.049,95%CI:1.001~1.100,P<0.05)、LVEDD(OR=1.265,95%CI:1.080~1.481,P<0.05)、cTnI(OR=1.752,95%CI:1.019~3.012,P<0.01)为DCM患者药物治疗无反应的危险因素。ROC曲线显示:HE4预测DCM患者药物治疗反应性的AUC为0.672(95%CI:0.512~0.707),特异度为53.13%,灵敏度为75.00%;NTproBNP预测AUC为0.802(95%CI:0.756~0.908),特异度为81.25%,灵敏度为70.00%;cTnI预测AUC为0.613(95%CI:0.506~0.720),特异度为79.69%,灵敏度为40.00%;LVEDD预测AUC为0.715(95%CI:0.610~0.820),特异度为78.10%,灵敏度为62.50%;上述指标对比差异无统计学意义。限制性立方样条显示基线血清HE4水平与DCM患者治疗反应性呈非线性剂量-反应关系(P<0.05)。
        结论  血清HE4水平、NT-proBNP、cTnI与LVEDD与DCM患者药物治疗反应性有关,且血清HE4水平连续变化与DCM患者治疗反应性关联强度呈剂量-反应关系。

       

      Abstract:
        AIM   To investigate the assessment of baseline human epididymal protein 4 (HE4) levels and drug responsiveness in patients with dilated cardiomyopathy (DCM).
        METHODS  106 patients with DCM who were admitted to the Cardiovascular Department of the Hospital from January 2018 to December 2021 were selected as the study subjects. They were treated with standardized drugs in accordance with the Chinese Guidelines for the Diagnosis and Treatment of Dilated Cardiomyopathy. All general information was recorded, and baseline serum HE4 levels were detected by chemiluminescence method. Three months later, 2 patients lost their visits due to relocation. 104 patients were followed up, and 64 patients were classified into the response group, The other 40 cases were classified as non response group. Multivariate Logistic was used to screen the influencing factors of drug therapy responsiveness, and ROC curve was drawn to evaluate the efficacy of related factors in predicting drug therapy responsiveness. Restrictive cubic spline was used to fit the baseline serum HE4 level and drug therapy responsiveness.
        RESULTS  Compared with the non reaction group, cTnI, NT-proBNP, HE4 and LVEDD in the reaction group decreased; Multivariate logistic regression analysis showed that baseline serum NT-proBNP (OR=1.002, 95% CI:1.001~1.003, P<0.01), HE4 (OR=1.049, 95% CI:1.001~1.100, P<0.05), LVEDD (OR=1.265, 95% CI:1.080~1.481, P<0.05), cTnI (OR=1.752, 95% CI:1.019~3.012, P<0.01) were risk factors for drug unresponsiveness in DCM patients. ROC curve showed that the AUC of HE4 predicting the drug response of DCM patients was 0.672 (95% CI:0.512~0.707), the specificity was 53.13%, and the sensitivity was 75.00%; NT-proBNP predicted AUC of 0.802 (95% CI:0.756~0.908), specificity of 81.25%, and sensitivity of 70.00%; CTnI predicted AUC of 0.613 (95% CI:0.506~0.720), specificity of 79.69%, sensitivity of 40.00%; LVEDD predicted AUC of 0.715 (95% CI:0.610~0.820), specificity of 78.10%, and sensitivity of 62.50%; There was no statistically significant difference between the above indicators. The restricted cubic spline showed that there was a nonlinear dose response relationship between the baseline serum HE4 level and the treatment responsiveness of DCM patients (P<0.05).
        CONCLUSION  Serum HE4 levels, NT-proBNP, cTnI and LVEDD are associated with drug treatment responsiveness in DCM patients and continuous changes in serum HE4 levels show a dose-response relationship with treatment responsiveness in DCM patients.

       

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