关键词: 慢性心力衰竭, 心室重塑, 肠道菌群, 溶质载体家族7成员11, 可溶性肿瘤坏死因子受体2

Abstract: Objective To investigate the relationship of gut microbiota (GM), serum solute carrier family 7 member 11 (SLC7A11) and soluble tumor necrosis factor receptor 2 (sTNFR-2) expression levels with ventricular remodeling (VR) and prognosis in elderly patients with chronic heart failure (CHF). Methods From January 2022 to October 2024, 172 elderly patients with CHF who were treated in the First Affiliated Hospital of Xi’an Jiaotong University were enrolled in the CHF group. According to the New York Heart Association (NYHA) cardiac function classification, patients were divided into Group Ⅱ (61 cases), Group Ⅲ (56 cases), and Group Ⅳ (55 cases). Based on prognosis outcomes after 1 year, the patients were classified into a poor-prognosis group (54 cases) and a good-prognosis group (118 cases). The control group (HC group) consisted of 172 healthy individuals who underwent physical examinations and matched the study subjects in terms of age and gender ratio. Color Doppler echocardiography was employed to measure the left ventricular end-diastolic diameter (LVDD), left atrial diameter (LAD), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF); Genomic diversity was assessed via 16S rRNA gene sequencing with calculation of α-diversity index; differences in GM community structure were evaluated using principal coordinate analysis based on Bray-Curtis distance and permutational multivariate analysis; Serum SLC7A11 and sTNFR-2 levels were measured by ELISA method; Multifactorial logistic regression analysis was conducted to identify independent prognostic factors for CHF patients; Receiver operating characteristic (ROC) curves were utilized to evaluate the predictive value of GM levels and serum SLC7A11/sTNFR-2 levels for CHF prognosis, with internal validation performed using bootstrap resampling. Results Compared with the HC group, the serum SLC7A11 level was significantly reduced and the sTNFR-2 level was significantly elevated in the CHF group (P<0.05). Statistically significant differences were observed between the HC group and the CHF group in the composition of the GM microbiota (R²=0.201, P<0.05). As the NYHA cardiac function classification progressed, the Chao1 index, Shannon index, serum SLC7A11 level, and LVEF in CHF patients showed a gradual decline, whereas LVDD, LAD, LVMI, and serum sTNFR-2 levels exhibited a progressive increase (P<0.05). Compared with the good-prognosis group, the poor-prognosis group demonstrated a longer disease duration, higher serum sTNFR-2 levels, a greater proportion of NYHA class Ⅳ cases, increased LVDD, LAD, LVMI, and relative abundance of Proteobacteria, as well as decreased LVEF, serum SLC7A11 levels, and relative abundance of Firmicutes (P<0.05). After adjusting for disease duration and traditional cardiac function parameters, elevated Firmicutes and SLC7A11 remained independent protective factors, while elevated Proteobacteria and sTNFR-2 remained independent risk factors (P<0.05). The area under the curve (AUC) values for predicting CHF prognosis by Firmicutes and Proteobacteria, serum SLC7A11, and sTNFR-2 alone were 0.803,0.804,0.816, and 0.838, respectively; the combined model achieved an AUC of 0.948, significantly superior to any single predictor (P<0.05). The combined model demonstrated good calibration accuracy and strong consistency with actual clinical outcomes. Conclusions The NYHA cardiac function in elderly patients with CHF are closely related to VR. Moreover, the combination of the Phylum Firmicutes, the Proteobacteria, and the levels of serum SLC7A11 and sTNFR-2 can effectively enhance the assessment value for the prognosis of patients with CHF.

Key words: chronic heart failure, ventricular remodeling, gut microbiota, solute carrier family 7 member 11, soluble tumor necrosis factor receptor 2