重度心力衰竭患者血清RDW、CPP、NT-proANP的临床意义及其与预后相关性分析

摘要 目的：探讨重度心力衰竭患者血清红细胞分布宽度（RDW）、和肽素（CPP）、氨基末端 A 型利钠肽（NT-proANP）的临床意义及其与预后相关性。方法：选取我院2020年1月与到2022年12月收治的98例心力衰竭患者作为研究对象，将所有患者应用Killip分级进行分组，Ⅰ级16例，Ⅱ级23例，Ⅲ级例21，Ⅳ级38例，并选取同期来我院体检的50名健康志愿者作为对照组，对比五组患者血清RDW、CPP、NT-proANP表达水平，分析RDW、CPP、NT-proANP与重度心力衰竭的相关性。随后将Ⅲ级与Ⅳ级重度心力衰竭的59例患者依照其预后情况分为死亡组（n=21）和存活组（n=38），对比两组患者临床一般情况与血清RDW、CPP、NT-proANP表达水平，并分析血清RDW、CPP、NT-proANP对重度心力衰竭的预后预测价值。结果：五组受检者血清RDW、CPP、NT-proANP水平对比差异显著，Ⅳ级组明显高于Ⅲ级、Ⅱ级、Ⅰ级和对照组（P＜0.05）；Spearman相关分析结果显示：血清RDW、CPP、NT-proANP与重度心力衰竭呈正相关（P＜0.05）；曲线下面积(AUC)从依次为RDW (0.688)、CPP（0.667）、NT-proANP（0.656）、三者联合（0.671）。RDW诊断灵敏度为67.61 %，特异度为66.85 %，CPP诊断灵敏度为60.03 %，特异度为67.53%，NT-proANP诊断灵敏度为61.24 %，特异度为66.53 %，三者联合诊断灵敏度为74.58 %，特异度为86.32 %；存活组与死亡组患者Killip分级、合并陈旧性心肌梗死、RDW、CPP、NT-proANP水平对比差异显著（P＜0.05）；logistic回归分析结果表明：RDW、CPP、NT-proANP为重度心力衰竭预后的独立预测指标（P＜0.05）。结论：血清RDW、CPP、NT-proANP与重度心力衰竭具有明显相关性，其对于重度心力衰竭的诊断临界值分别为17.58 %、1772.62 pg/mL、1.12 nmol/mL。同时三者为重度心力衰竭预后不良的独立影响因素。

Clinical Significance of Serum RDW, CPP and NT-proANP in Patients with Severe Heart Failure and Their Correlation with Prognosis

ABSTRACT Objective: To investigate the clinical significance of serum red blood cell distribution width (RDW), cardiac peptide peptide (CPP) and amino-terminal type A natriuretic peptide (NT-proANP) in patients with severe heart failure and their correlation with prognosis. Methods: 98 patients with heart failure admitted to our hospital from January 2020 to December 2023 were selected as the study subjects. All patients were divided into groups according to Killip classification, including 16 patients with grade I, 23 patients with grade II, 21 patients with grade III, and 38 patients with grade IV. 50 healthy volunteers who came to our hospital for physical examination at the same time were selected as the control group. The expression levels of serum RDW, CPP, and NT-proANP in five groups were compared, and the correlation between RDW, CPP, NT-proANP and severe heart failure was analyzed. Subsequently, 59 patients with severe heart failure of grade III and IV were divided into death group(n=21) and survival group(n=38) according to their prognosis. The clinical general situation and the expression level of serum RDW, CPP, NT-proANP were compared between the two groups, and the prognostic value of serum RDW, CPP, NT-proANP for severe heart failure was analyzed. Results: The levels of serum RDW, CPP and NT-proANP were significantly different among the five groups. The level of serum RDW, CPP and NT-proANP in grade IV group was significantly higher than that in grade III, II, I and control group(P<0.05); Spearman correlation analysis showed that serum RDW, CPP, NT-proANP were positively correlated with severe heart failure (P<0.05); The area under the curve (AUC) is RDW (0.688), CPP (0.667), NT-proANP (0.656), and the combination of the three (0.671). The diagnostic sensitivity of RDW is 67.61 %, the specificity is 66.85%, the diagnostic sensitivity of CPP is 60.03 %, the specificity is 67.53 %, the diagnostic sensitivity of NT-proANP is 61.24 %, the specificity is 66.53%, the combined diagnostic sensitivity of the three is 74.58 %, the specificity is 86.32 %; There were significant differences in Killip grade, levels of RDW, CPP, NT proANP between the survival group and the death group(P<0.05); The results of logistic regression analysis showed that RDW, CPP and NT-proANP were independent predictors of the prognosis of severe heart failure(P<0.05). Conclusion: Serum RDW, CPP and NT-proANP are significantly correlated with severe heart failure, and their diagnostic thresholds for severe heart failure are 17.58 %, 1772.62 pg/mL and 1.12 nmol/mL, respectively. At the same time, the three factors are independent influencing factors for poor prognosis of severe heart failure.