血清TSP-1、Apela水平在冠状动脉粥样硬化性心脏病慢性心力衰竭患者中的表达及意义

doi:10.3760/cma.j.cn441417-20241014-11005

摘要/Abstract

摘要：

目的　检测血清血小板反应蛋白1（TSP-1）、Apela水平在冠状动脉粥样硬化性心脏病（CHD）慢性心力衰竭（CHF）患者中的表达，并分析其临床意义。方法　选取2023年1月至2024年1月西安交通大学第一附属医院收治的CHD合并CHF患者129例，纳入CHD合并CHF组；选取同期收治的单纯CHD无CHF患者129例，纳入CHD组；选取同期体检健康受试者129例，纳入健康组。CHD合并CHF组男65例，女64例；年龄54～78（66.38±9.10）岁；体重指数（BMI）18.09～32.16（23.47±2.97）kg/m²。CHD组男68例，女61例；年龄56～76（67.41±8.67）岁；BMI 18.17～31.15（23.39±3.06）kg/m²。健康组男63例，女66例；年龄54～76（66.95±8.96）岁；BMI 18.23～30.96（23.34±3.11）kg/m²。比较387例受试者血清TSP-1、Apela水平；比较不同纽约心脏病协会（NYHA）心功能分级CHD合并CHF患者血清TSP-1、Apela水平；采用Pearson相关性分析法分析血清TSP-1、Apela水平与CHD合并CHF患者心功能指标的相关性；随访统计CHD合并CHF患者预后，根据预后情况分为预后不良组（28例）和预后良好组（91例），比较两组一般资料及血清TSP-1、Apela水平；采用多因素logistic回归分析CHD合并CHF患者预后不良的影响因素。采用独立样本t检验、方差分析、LSD-t检验、Mann-Whitney U检验和χ²检验进行统计学分析。结果　CHD组、CHD合并CHF组血清TSP-1水平均高于健康组，血清Apela水平均低于健康组（均P<0.05）；CHD合并CHF组血清TSP-1水平高于CHD组，血清Apela水平低于CHD组（均P<0.05）。Ⅲ级、Ⅳ级CHD合并CHF患者血清TSP-1水平均高于Ⅱ级患者，血清Apela水平均低于Ⅱ级患者（均P<0.05）；Ⅳ级CHD合并CHF患者血清TSP-1水平高于Ⅲ级患者，血清Apela水平低于Ⅲ级患者（均P<0.05）。Pearson相关性分析显示，血清TSP-1水平与CHD合并CHF患者左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）均呈正相关，与左心室射血分数（LVEF）呈负相关（均P<0.05）；血清Apela水平与CHD合并CHF患者LVEDD、LVESD、LVEDV、LVESV均呈负相关，与LVEF呈正相关（均P<0.05）。随访时间6～18个月，中位随访时间12个月，129例CHD合并CHF患者失访10例，其余119例中28例预后不良（23.53%）。预后不良组吸烟、病变血管数量≥3支、院外不规律用药构成比及血清TSP-1水平、Gensini积分均高于预后良好组［46.43%（13/28）比24.18%（22/91）、32.14%（9/28）比13.19%（12/91）、25.00%（7/28）比9.89%（9/91）、（9.14±2.16）μg/L比（7.47±2.02）μg/L、45（31，62）分比41（26，58）分］，血清Apela水平低于预后良好组［（2.65±0.68）μg/L比（3.48±0.54）μg/L］（均P<0.05）。多因素logistic回归分析结果显示，吸烟（OR=1.687，95%CI 1.007～2.826）、高Gensini积分（OR=1.864，95%CI 1.200～2.894）、高血清TSP-1水平（OR=2.087，95%CI 1.209～3.602）、院外不规律用药（OR=1.830，95%CI 1.268～2.641）均是预后不良的独立危险因素，高血清Apela水平（OR=0.556，95%CI 0.369～0.837）是独立保护因素（均P<0.05）。结论　CHD合并CHF患者血清TSP-1、Apela水平均与心功能密切相关，均是CHD合并CHF患者预后的影响因素。

关键词:

冠状动脉粥样硬化性心脏病, 慢性心力衰竭, 血小板反应蛋白1, Apela

Abstract:

Objective　To detect the expressions of serum thrombospondin-1 (TSP-1) and Apela in patients with coronary atherosclerotic heart disease (CHD) and chronic heart failure (CHF), and to analyze their clinical significance. Methods　129 patients with CHD combined with CHF who were admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January 2023 to January 2024 were selected and included in the CHD+CHF group; 129 patients with only CHD without CHF who were admitted during the same period were selected and included in the CHD group; 129 healthy subjects who underwent physical examinations during the same period were selected and included in the healthy group. There were 65 males and 64 females in the CHD+CHF group, aged 54-78 (66.38±9.10) years, body mass index (BMI) 18.09-32.16 (23.47±2.97) kg/m². There were 68 males and 61 females in the CHD group, aged 56-76 (67.41±8.67) years, BMI 18.17-31.15 (23.39±3.06) kg/m². There were 63 males and 66 females in the healthy group, aged 54-76 (66.95±8.96) years, BMI 18.23-30.96 (23.34±3.11) kg/m². Compare the levels of serum TSP-1 and Apela in 387 subjects; compare the levels of serum TSP-1 and Apela in patients with CHD combined with CHF of different New York Heart Association (NYHA) cardiac function grades; use Pearson correlation analysis method to analyze the correlation between serum TSP-1 and Apela levels and the cardiac function indicators of patients with CHD combined with CHF; follow-up and statistically analyze the prognosis of patients with CHD combined with CHF, divide them into the poor prognosis group (28 cases) and the good prognosis group (91 cases), compare the general data and serum TSP-1 and Apela levels of the two groups; use multivariate logistic regression analysis to analyze the influencing factors of poor prognosis in patients with CHD combined with CHF. Independent sample t test, analysis of variance, LSD-t test, Mann-Whitney U test, and χ² test were used for statistical analysis. Results　The serum TSP-1 levels in the CHD group and the CHD+CHF group were both higher than those in the healthy group, while the serum Apela levels were both lower than those in the healthy group (all P<0.05); the serum TSP-1 level in the CHD+CHF group was higher than that in the CHD group, while the serum Apela level was lower than that in the CHD group (both P<0.05). The serum TSP-1 levels of patients with grades Ⅲ and grade Ⅳ CHD combined with CHF were higher than those of patients with grade Ⅱ, and the serum Apela levels were lower than those of patients with grade Ⅱ (all P<0.05); the serum TSP-1 level of patients with grade Ⅳ CHD combined with CHF was higher than that of patients with grade Ⅲ, while the serum Apela level was lower than that of patients with grade Ⅲ (both P<0.05). The Pearson correlation analysis showed that the serum TSP-1 level was positively correlated with the left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV) in patients with CHD combined with CHF, and negatively correlated with the left ventricular ejection fraction (LVEF) (all P<0.05). The follow-up period was 6 to 18 months, with a median follow-up time of 12 months. Among the 129 patients with CHD and CHF, 10 were lost to follow-up, leaving 119 patients. Among them, 28 had a poor prognosis (23.53%). The poor prognosis group had higher proportions of smoking, more than 3 diseased blood vessels, irregular medication outside the hospital, as well as higher serum TSP-1 level and Gensini score compared to the good prognosis group [46.43% (13/28) vs. 24.18% (22/91), 32.14% (9/28) vs. 13.19% (12/91), 25.00% (7/28) vs. 9.89% (9/91), (9.14±2.16) μg/L vs. (7.47±2.02) μg/L, 45 (31,62) points vs. 41 (26,58) points](all P<0.05). The serum Apela level was lower in the poor prognosis group than in the good prognosis group [(2.65±0.68) μg/L vs. (3.48±0.54) μg/L](P<0.05). The results of multivariate logistic regression analysis showed that smoking (OR=1.687, 95%CI 1.007-2.826), high Gensini score (OR=1.864, 95%CI 1.200-2.894), high serum TSP-1 level (OR=2.087, 95%CI 1.209-3.602), and irregular medication outside the hospital (OR=1.830, 95%CI 1.268-2.641) were all independent risk factors for poor prognosis, while high serum Apela level (OR=0.556, 95%CI 0.369-0.837) was an independent protective factor (all P<0.05). Conclusion　The serum levels of TSP-1 and Apela in patients with CHD combined with CHF are closely related to cardiac function, and both are influencing factors for the prognosis of patients with CHD combined with CHF.

Key words: Coronary heart disease, Chronic heart failure, Thrombospondin-1, Apela

刘馨玉石永朋高渊. 血清TSP-1、Apela水平在冠状动脉粥样硬化性心脏病慢性心力衰竭患者中的表达及意义 [J]. 国际医药卫生导报, 2025, 31(11): 1784-1790.

Liu Xinyu, Shi Yongpeng, Gao Yuan.

Expressions and clinical significance of serum TSP-1 and Apela levels in patients with chronic heart failure secondary to coronary atherosclerotic heart disease [J]. International Medicine and Health Guidance News, 2025, 31(11): 1784-1790.

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