摘要
目的探究老年心肌肥厚患者心肌淀粉样变(CA)情况及对血清N末端B型钠尿肽前体(NT-proBNP)、肌钙蛋白T(cTnT)、免疫球蛋白M(IgM)和预后的影响。方法选取黄冈市中心医院收治的220例老年心肌肥厚患者,进行超声及组织病理检查,统计患者CA发生情况,将伴CA患者纳入CA组37例,不伴CA患者纳入非CA组183例,比较2组患者血清NT-proBNP、cTnT、IgM水平,随访1年,存活123例(生存组),死亡97例(死亡组)。结果CA组血清NT-proBNP、cTnT水平高于非CA组,IgM水平低于非CA组(P<0.01);死亡组患者心功能Ⅲ~Ⅳ级、伴有CA、NT-proBNP、cTnT水平高于生存组,LVEF及IgM水平低于生存组(P<0.05,P<0.01)。Cox风险回归模型结果显示,心功能Ⅲ~Ⅳ级、伴有CA、血清NT-proBNP及cTnT升高,IgM降低是老年心肌肥厚患者死亡的独立影响因素(P<0.05,P<0.01);随访1年,CA组37例患者存活12例,1年生存率32.43%,中位生存时间9个月(95%CI:7.67~10.33);非CA组183例患者存活111例,1年生存率60.66%,中位生存时间12个月(95%CI:11.75~12.25),CA组患者总生存时间短于非CA组(log rankχ2=19.085,P<0.05)。结论出现CA的老年心肌肥厚患者血清NT-proBNP及cTnT水平升高,IgM水平降低,患者总生存时间显著缩短。
Objective To explore the cardiac amyloidosis(CA)in elderly patients with cardiac hypertrophy and its effects on prognosis and serum levels of N-terminal pro-B-type natriuretic peptide(NT-proBNP),cardiac troponin T(cTnT)and immunoglobulin M(IgM).Methods A total of 220 elderly patients with cardiac hypertrophy undergoing ultrasound and histopathological examinations in our hospital from April 2020 to March 2022 were recruited in this study.According to occurrence of CA,37 patients were assigned into CA group and another 183 patients were included in the non-CA group.Serum levels of NT-proBNP,cTnT and IgM were compared between the two groups.During one year's follow-up,the survived were assigned into survival group(123 cases)and the dead into death group(97 cases).Results The serum levels of NT-proBNP and cTnT were significantly higher,and that of IgM was obviously lower in the CA group than the non-CA group(P<0.01).The death group had larger proportions of heart function gradeⅢ-Ⅳand complication of CA,higher serum NT-proBNP and cTnT levels,and lower LVEF and IgM level when compared to the survival group(P<0.05,P<0.01).Cox risk regression model showed that cardiac function gradeⅢ-Ⅳ,CA,high serum levels of NT-proBNP and cTnT,and low level of IgM were independent influencing factors of death in elderly patients with cardiac hypertrophy(P<0.05,P<0.01).In 1 year of follow-up,there were 12 patients survival in the CA group,with a 1-year survival rate and median survival time were 32.43%(12/37)and 9 months(95%CI:7.67-10.33),and 111 patients survived in the non-CA group,with a survival rate of 60.66%(111/183)and a median time of 12 months(95%CI:11.75-12.25).The total survival time was statistically shorter in the patients from the CA group than those from the non-CA group(log rankχ^2=19.085,P<0.05).Conclusion Serum NT-proBNP and cTnT levels are increased while IgM level is decreased in elderly cardiac hypertrophy patients complicated with CA,and they have significantly shortened total survival time than those without CA.
作者
单华静
陈少泽
黄能为
Shan Huajing;Chen Shaoze;Huang Nengwei(Department of Cardiovascular Medicine,Central Hospital of HuanggangCity,Huanggang 438000,Hubei Province,China)
出处
《中华老年心脑血管病杂志》
CAS
北大核心
2023年第9期927-930,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
黄冈市级科技计划项目(XQYF2019000009)。
