金属蛋白酶组织抑制因子对老年慢性心力衰竭病人院内死亡的预测价值

doi:10.3969/j.issn.1003-9198.2021.11.014

摘要/Abstract

摘要： 目的探讨金属蛋白酶组织抑制因子对老年CHF病人院内死亡的预测价值。方法选取2018年1月至2020年1月在本院进行治疗的老年CHF病人394例,分为院内死亡组40例、非院内死亡组354例,对比2组入院后早期金属蛋白酶组织抑制因子(TIMPs)水平的差异,采用Logistics回归分析老年CHF病人院内死亡的危险因素。采用ROC曲线分析危险因素对老年CHF病人院内死亡的预测价值。结果院内死亡组病人入院后早期血清TIMP-1、TIMP-2、TIMP-4的水平均低于非院内死亡组(P＜0.05)。ROC曲线显示,入院后早期血清TIMP-1水平预测老年CHF病人院内死亡的最佳截断值为149.40 pg/mL,AUC为0.751(95%CI为0.657~0.846),灵敏度、特异度分别为74.07%、62.50%; TIMP-2预测死亡的最佳截断值为180.30 pg/mL,AUC为0.819(95%CI为 0.734~0.905),灵敏度、特异度分别为78.75%、75.00%;TIMP-4预测CHF病人院内死亡的最佳截断值为193.30 pg/mL,AUC为0.746(95%CI为0.649~0.843),灵敏度、特异度分别为63.75%、70.00%。Logistics回归分析发现,年龄＞70岁、Hb水平较低、TIMP-1＜149.40 pg/mL、TIMP-2＜180.30 pg/mL、TIMP-4＜193.30 pg/mL、NT-proBNP水平较高是老年CHF病人院内死亡的独立危险因素(P＜0.05)。结论老年CHF病人入院后早期血清TIMP-1、TIMP-2、TIMP-4水平较低是其院内死亡的独立危险因素,且对该结局具有早期预测价值。

关键词: 老年人, 慢性心力衰竭, 金属蛋白酶组织抑制因子, 院内死亡, 预测价值

Abstract: Objective To evaluate the predictive value of metalloproteinase-inhibiting factors (TIMPs) for in-hospital death in the elderly patients with chronic heart failure. Methods A total of 394 patients with CHF in our hospital during January 2018 to January 2020 were divided into in-hospital death group(n=40) and non-in-hospital death group(n=354). The levels of TIMPs were compared between the two groups. The risk factors of in-hospital death were analyzed by Logistics regression model. ROC curve was used to analyze the predict value for in-hospital death. Results Early serum levels of TIMP-1, TIMP-2 and TIMP-4 in in-hospital death group were lower than those in non-in-hospital death group(P<0.05). ROC curve showed that optimal cut-off value of serum TIMP-1 at the early stage after admission was 149.40 pg/mL, with an AUC of 0.751(95%CI: 0.657-0.846), with a sensitivity and specificity of 74.07% and 62.50% respectively. Optimal cut off value of serum TIMP-2 was 180.30 pg/mL, with an AUC of 0.819(95%CI: 0.734-0.905), with a sensitivity and specificity of 78.75% and 75.00% respectively. Optimal cut off value of TIMP-4 was 193.30 pg/mL, with an AUC of 0.746(95%CI: 0.649-0.843), with a sensitivity and specificity of 63.75% and 70.00% respectively. According to Logistics regression analysis, age over 70 years old, low hemoglobin level, TIMP-1<149.40 pg/mL, TIMP-2<180.30 pg/mL, TIMP-4<193.30 pg/mL, high NT-proBNP level were independent risk factors for in-hospital death in the elderly CHF patients(P<0.05). Conclusions Low serum levels of TIMP-1, TIMP-2 and TIMP-4 are independent risk factors for in-hospital death in the elderly patients with CHF after admission, which has early predictive value for in-hospital death.

Key words: aged, chronic heart failure, metalloproteinase tissue inhibitor, in-hospital death, predict value

中图分类号:

R 541.6

李军, 吕振, 李蓓蓓. 金属蛋白酶组织抑制因子对老年慢性心力衰竭病人院内死亡的预测价值[J]. 实用老年医学, 2021, 35(11): 1162-1165.

LI Jun, LYU Zhen, LI Bei-bei. Predictive value of metalloproteinase-inhibiting factors for in-hospital death in elderly patients with chronic heart failure[J]. Practical Geriatrics, 2021, 35(11): 1162-1165.

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