目的 探讨慢性心力衰竭(CHF)患者血浆组织型金属蛋白酶抑制剂-4(TIMP-4)、可溶性E-选择素(sES)和游离脂肪酸(FFA)的动态变化以及判断预后的临床价值.方法 选择确诊CHF患者118例,根据心力衰竭严重程度分为:轻度组,共73例,心功能分级(NYHA)Ⅱ级;重度组,共45例,心功能分级(NHA)Ⅲ～Ⅳ级.于治疗的第1、3、6、12个月分别检测并比较两组患者血浆N末端脑钠肽原(NT-proBNP)、TIMP-4、sES及FFA水平的差异.随访1年,记录并比较两组患者的生存率.应用多元Logistic回归分析上述指标与生存率的相关性.结果 与轻度组比较,在治疗第1、3、6、12个月重度组患者的血浆NT-proBNP、sES及FFA水平均显著升高(均P＜0.05),而重度组患者的血浆TIMP-4水平降低(P＜0.05).两组患者血浆NT-proBNP、sES及FFA水平随治疗时间延长呈现逐渐降低趋势,而两组患者血浆TIMP-4水平则随治疗时间延长而逐渐增加(P＜0.05).随访1年,重度组的生存率显著低于轻度组(P＜0.05),且死亡组血浆TIMP-4水平显著低于存活组,但血浆NT-proBNP、sES及FFA水平显著高于存活组(P＜0.05).Logistic回归分析显示,血浆NT-proBNP、sES及FFA水平为CHF患者生存的危险因素(OR=0.02～2.20,均P＜0.05),而TIMP-4为CHF的保护因素(OR=0.50,P＜0.05).结论 血浆TIMP-4、sES及FFA动态变化能评估慢性心力衰竭的程度,对预后结局判断有预测价值.%Objective To explore the clinical value of the dynamic variation of plasma levels of the tissue inhibitor of metalloproteinase (TIMP)-4,soluble E selectin (sES) and free fatty acids (FFA) in patients with chronic heart failure (CHF) as well as the correlation of plasma levels of TIMP-4,sES and FFA to prognostic judgment.Methods A total of 118 patients with CHF were collected and divided into two groups according to the degree of CHF,which were mild group (73 cases,cardiac NYH class 2) and severe group (45 cases,cardiac NYHA class 3 to 4).The plasma levels of NT-proBNP,TIMP-4,sES and FFA were detected and compared between two groups at 1st,3th,6th,12th month post-therapy respectively.The survival rates were compared between two groups after one-year follow-up.The correlation between the above indexes and the risk factors of CHF survival rate were confirmed by multivariate Logistic analysis.Results At any point of time,plasma levels of the NT-proBNP,sES and FFA in severe group were significantly increased (all P ＜ 0.05) but the plasma level of TIMP-4 in severe group was significantly decreased (P ＜ 0.05) when compared with the mild group.As the duration of treatment prolonged,the plasma levels of NT-proBNP,sES and FFA in two groups were decreasing with statistical significance (all P ＜ 0.05) whereas theTIMP-4 in two groups were increasing with statistical significance (P ＜ 0.05).After a follow-up of one year,the survival rates in severe group were significantly lower than mild group (P =0.035)Compared to survival group,the plasma level of TIMP-4 in death group was significantly lower (P ＜ 0.05) whereas the NT-proB-NP,sES and FFA plasma levels of death group were significantly higher (all P ＜ 0.05).According to muhivariate Logistic analysis,the NT-proBNP,sES and FFA plasma levels were risk factors to the survival rate of CHF ((OR =0.02 ～ 2.20,P ＜ 0.05) while the TIMP-4 plasma level was protective factor to CHF (OR =0.50,P ＜ 0.05).Conclusions Since the plasma levels of TIMP-4,sES and FFA could assess the degree of CHF,they have predictive value for prognostic outcomes.
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