作者：何大渊，罗璐莉，陈兴武，高亮，魏伯栋

单位：

734000甘肃省张掖市，河西学院附属张掖人民医院心内科 通信作者：何大渊，E-mail：hdydoctor@qq.com

Units：

Department of Cardiology, Zhangye People's Hospital Affiliated to Hexi University, Zhangye 734000, China Corresponding author: HE Dayuan, E-mail: hdydoctor@qq.com

关键词：

心肌病,扩张型; 心室重构; 基质金属蛋白酶; 危险因素;

Keywords：

Cardiomyopathy, dilated; Ventricular remodeling; Matrix metalloproteinase; Risk factors

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.144

Funds：

摘要：

目的 探讨扩张型心肌病(DCM)患者合并心室重构的影响因素。方法 选取2017年1月至2020年1月河西学院附属张掖人民医院收治的102例DCM合并心室重构患者(DCM合并心室重构组)与100例单纯DCM患者(DCM组)为研究对象。比较两组基线资料(性别、年龄、吸烟史、饮酒史、合并症)及实验室检查指标[基质金属蛋白酶(MMP)-1、MMP-2、MMP-9、可溶性信号素4D(sSema4D)、组织金属蛋白酶抑制物1(TIMP-1)、N末端脑钠肽前体(NT-proBNP)水平]及心外膜脂肪组织(EAT)厚度。采用ROC曲线分析实验室检查指标、EAT厚度预测DCM患者合并心室重构的最佳截断值。采用多因素Logistic回归分析探讨DCM患者合并心室重构的影响因素。结果 DCM合并心室重构组MMP-1、MMP-2、MMP-9、sSema4D、NT-proBNP水平高于DCM组,TIMP-1水平低于DCM组,EAT厚度大于DCM组(P<0.05)。ROC曲线分析结果显示,MMP-1、MMP-2、MMP-9、sSema4D、TIMP-1、NT-proBNP、EAT厚度预测DCM患者合并心室重构的最佳截断值分别为3.37μg/L、3.88μg/L、1.44μg/L、5.98μg/L、0.58μg/L、9.6μg/L、5.53 mm。多因素Logistic回归分析结果显示,MMP-1≥3.37μg/L、MMP-2≥3.88μg/L、MMP-9≥1.44μg/L、sSema4D≥5.98μg/L、TIMP-1≤0.58μg/L、NT-proBNP≥9.6μg/L、EAT厚度≥5.53 mm是DCM患者合并心室重构的危险因素(P<0.05)。结论 MMP-1≥3.37μg/L、MMP-2≥3.88μg/L、MMP-9≥1.44μg/L、sSema4D≥5.98μg/L、TIMP-1≤0.58μg/L、NT-proBNP≥9.6μg/L、EAT厚度≥5.53 mm是DCM患者合并心室重构的危险因素。

Abstract：

【Abstract】　Objective To explore the influencing factors of ventricular remodeling in patients with dilatedcardiomyopathy (DCM) . Methods A total of 102 patients with DCM combined with ventricular remodeling (DCM combined withventricular remodeling group) and 100 patients with DCM (DCM group) admitted to Zhangye People's Hospital Affiliated to HexiUniversity from January 2017 to January 2020 were selected as the research objects. Baseline data (sex, age, smoking history,drinking history, comorbidities) and laboratory indicators [levels of matrix metalloproteinase (MMP) -1 , MMP-2, MMP-9, solublesemaphore 4D (sSema4D) , metalloproteinase inhibitor (TIMP-1) , N-terminal pro-brain natriuretic peptide (NT-proBNP) ] ,epicardial adipose tissue (EAT) thickness were compared between the two groups. The ROC curve was used to analyze the bestcut-off value of laboratory indicators and EAT thickness for predicting ventricular remodeling in patients with DCM. MultivariateLogistic regression was used to analyze the influencing factors of ventricular remodeling in patients with DCM. Results Thelevels of MMP-1, MMP-2, MMP-9, sSema4D and NT-proBNP in the DCM combined with ventricular remodeling group werehigher than those in the DCM group, the level of TIMP-1 was lower than that in the DCM group, and EAT thickness was biggerthan that in the DCM group (P <0.05) . ROC curve analysis result showed that the best cut-off value of levels of MMP-1, MMP-2, MMP-9, sSema4D, TIMP-1, NT -proBNP and EAT thickness for predicting ventricular remodeling in patients with DCM were3.37 μg/L, 3.88 μg/L, 1.44 μg/L, 5.98 μg/L, 0.58 μg/L, 9.6 μg/L, 5.53 mm. Multivariate Logistic regression analysis resultsshowed that MMP-1 ≥ 3.37 μg/L, MMP-2 ≥ 3.88 μg/L, MMP-9 ≥ 1.44 μg/L, sSema4D ≥ 5.98 μg/L, TIMP-1 ≤ 0.58 μg/L,NT-proBNP ≥ 9.6 μg/L, EAT thickness ≥ 5.53 mm were risk factors for ventricular remodeling in patients with DCM (P <0.05) .Conclusion MMP-1 ≥ 3.37 μg/L, MMP-2 ≥ 3.88 μg/L, MMP-9 ≥ 1.44 μg/L, sSema4D ≥ 5.98 μg/L, TIMP-1 ≤ 0.58 μg/L,NT-proBNP≥ 9.6 μg/L, EAT thickness≥ 5.53 mm are risk factors for ventricular remodeling in patients with DCM.

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