Correlations between soluble growth stimulation expressed gene 2 protein, myoglobin, interleukin-6 levels and cardiac function in elderly patients with diastolic heart failure complicated with sarcopenia
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摘要:目的
探讨老年舒张性心力衰竭(DHF)合并肌少症患者外周血可溶性生长刺激表达基因2蛋白(sST2)、肌红蛋白(Myo)、白细胞介素-6(IL-6)水平与心功能的相关性。
方法将122例DHF患者根据有无肌少症分为DHF合并肌少症组60例和DHF组62例, 另将健康体检者58例、单纯肌少症患者60例分别纳入对照组、单纯肌少症组, 检测各组外周血sST2、Myo、IL-6水平和心功能指标[左室射血分数(LVEF)、心排血量(CO)、心率(HR)、每搏输出量(SV)和心脏指数(CI)]。采用Pearson相关分析法分析sST2、Myo、IL-6与各心功能指标的相关性。绘制受试者工作特征(ROC)曲线, 分析sST2、Myo、IL-6单独及联合诊断DHF合并肌少症的效能。
结果与对照组、单纯肌少症组相比, DHF组、DHF合并肌少症组sST2、Myo、IL-6水平和HR均升高, LVEF、CO、SV和CI均降低, 差异有统计学意义(P < 0.05); 与DHF组相比, DHF合并肌少症组sST2、Myo、IL-6水平和HR均升高, LVEF、CO、SV和CI均降低, 差异有统计学意义(P < 0.05)。sST2、Myo、IL-6均分别与LVEF、CO、SV、CI呈负相关(P < 0.001), 均与HR呈正相关(P < 0.001); sST2、Myo、IL-6、LVEF、SV是DHF合并肌少症的独立影响因素(P < 0.05); sST2、Myo、IL-6联合诊断DHF合并肌少症的曲线下面积为0.936, 诊断效能优于三者单独检测。
结论老年DHF合并肌少症患者外周血sST2、Myo、IL-6水平显著升高, 且sST2、Myo、IL-6均与心功能指标显著相关, 三者联合检测对DHF合并肌少症的诊断效能较高。
Abstract:ObjectiveTo investigate the relationship between the levels of soluble growth stimulation expressed gene 2 protein (sST2), myoglobin (Myo), interleukin-6 (IL-6) in peripheral blood and cardiac function in elderly patients with diastolic heart failure (DHF) complicated with sarcopenia.
MethodsA total of 122 patients with DHF were divided into DHF complicated with sarcopenia group (60 cases) and DHF group (62 cases) according to the presence or absence of sarcopenia. In addition, 58 healthy healthy population with physical examination and 60 patients with sarcopenia alone were included in the control group and sarcopenia alone group, respectively. The levels of sST2, Myo, IL-6 and cardiac function indexes[left ventricular ejection fraction (LVEF), cardiac output (CO), heart rate (HR), stroke volume (SV), and cardiac index (CI)]were measured in each group. Pearson correlation analysis was used to analyze the correlations between sST2, Myo, IL-6 and each cardiac function index. Receiver operating characteristic (ROC) curves were drawn to analyze the diagnostic efficacy of sST2, Myo, IL-6 alone and their combination in diagnosing DHF complicated with sarcopenia.
ResultsCompared with the control groupand the sarcopenia alone group, the levels of sST2, Myo, IL-6 and HR were increased, while LVEF, CO, SV, and CI were decreased in the DHF group and the DHF complicated with sarcopenia group (P < 0.05). Compared with the DHF group, the levels of sST2, Myo, IL-6 and HR were increased, while LVEF, CO, SV, and CI were decreased in the DHF complicated with sarcopenia group (P < 0.05). The sST2, Myo, and IL-6 were negatively correlated with LVEF, CO, SV, and CI (P < 0.001), and positively correlated with HR (P < 0.001). The sST2, Myo, IL-6, LVEF, and SV were independent influencing factors for DHF complicated with sarcopenia (P < 0.05). The area under the curve of combined detection of sST2, Myo, and IL-6 for diagnosing DHF complicated with sarcopenia was 0.936, indicating a better diagnostic efficacy than individual tests.
ConclusionThe levels of sST2, Myo, and IL-6 in peripheral blood are significantly increased in elderly patients with DHF complicated with sarcopenia, and these markers are significantly correlated with cardiac function indexes. Combined detection of these three markers has a higher diagnostic efficacy for DHF complicated with sarcopenia.
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表 1 4组受试者一般资料比较(x±s)[n(%)]
一般资料 分类 对照组(n=58) 单纯肌少症组(n=60) DHF组(n=62) DHF合并肌少症组(n=60) t/χ2 P 性别 男 32(55.17) 30(50.00) 36(58.06) 39(65.00) 2.875 0.411 女 26(44.83) 30(50.00) 26(41.94) 21(35.00) 年龄/岁 67.62±5.65 65.82±9.15 66.39±5.98 68.24±7.12 1.458 0.227 体质量指数/(kg/m2) 22.95±2.15 22.63±2.09 23.61±2.34 23.44±2.19 2.534 0.058 病程/年 — 4.96±2.69 4.65±3.65 4.96±3.48 0.169 0.845 学历 小学及以下 15(25.86) 16(26.67) 16(25.81) 14(23.33) 1.161 0.980 中学/中专 19(32.76) 15(25.00) 20(32.26) 21(35.00) 大专及以上 24(41.38) 29(48.33) 26(41.93) 25(41.67) 婚姻状况 已婚 38(65.52) 40(66.67) 32(51.61) 37(61.67) 3.617 0.306 离异/单身 20(34.48) 20(33.33) 30(48.39) 23(38.33) NYHA心功能分级 Ⅱ级 — — 42(67.74) 45(75.00) 0.823 0.663 Ⅲ级 — — 10(16.13) 8(13.33) Ⅳ级 — — 10(16.13) 7(11.67) NYHA: 纽约心脏病协会。 
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表 2 4组受试者外周血sST2、Myo、IL-6水平比较(x±s)
组别 n sST2/(ng/mL) Myo/(μg/L) IL-6/(μg/L) 对照组 58 59.49±7.37 53.54±6.76 13.60±2.80 单纯肌少症组 60 62.34±8.10 56.12±7.25 14.71±3.25 DHF组 62 71.72±11.95*# 152.31±20.63*# 92.17±7.11*# DHF合并肌少症组 60 81.15±7.60*#△ 183.03±31.19*#△ 120.20±20.37*#△ sST2: 可溶性生长刺激表达基因2蛋白; Myo: 肌红蛋白; IL-6: 白细胞介素-6。
与对照组比较, * P < 0.05; 与单纯肌少症组比较, #P < 0.05; 与DHF组比较, △P < 0.05。
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表 3 4组受试者心功能指标比较(x±s)
组别 n LVEF/% CO/(L/min) HR/min-1 SV/mL CI/[L/(min·m2)] 对照组 58 51.80±3.53 3.82±0.31 99.02±5.06 16.09±1.38 3.20±0.38 单纯肌少症组 60 51.85±2.98 3.75±0.29 100.21±6.12 15.98±1.54 3.16±0.42 DHF组 62 50.43±2.87*# 3.66±0.16*# 103.36±6.28*# 15.48±1.37*# 3.07±0.23*# DHF合并肌少症组 60 48.70±3.70*#△ 3.55±0.23*#△ 107.12±6.87*#△ 14.93±1.47*#△ 2.97±0.18*#△ LVEF: 左室射血分数; CO: 心排血量; HR: 心率; SV: 每搏输出量; CI: 心脏指数。
与对照组比较, * P < 0.05; 与单纯肌少症组比较, #P < 0.05; 与DHF组比较, △P < 0.05。
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表 4 外周血sST2、Myo和IL-6与心功能指标的相关性
指标 LVEF CO HR SV CI r P r P r P r P r P sST2 -0.279 < 0.001 -2.444 < 0.001 0.248 < 0.001 -0.244 < 0.001 -0.179 < 0.001 Myo -0.267 < 0.001 -0.359 < 0.001 0.346 < 0.001 -0.194 < 0.001 -0.189 < 0.001 IL-6 -0.311 < 0.001 -0.397 < 0.001 0.422 < 0.001 -0.306 < 0.001 -0.306 < 0.001
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表 5 DHF合并肌少症影响因素的多因素分析
因素 B S.E. Wals χ2 P Exp(B) 95%CI sST2 0.124 0.031 15.769 < 0.001 1.131 1.065~1.203 Myo 0.047 0.016 9.086 0.003 1.048 1.017~1.081 IL-6 0.122 0.031 15.416 < 0.001 1.130 1.063~1.201 LVEF -0.270 0.136 3.973 0.046 0.763 0.585~0.996 SV -0.602 0.288 4.375 0.036 0.548 0.312~0.963
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表 6 外周血sST2、Myo、IL-6单独及联合诊断DHF合并肌少症的效能
指标 曲线下面积 标准误 P 截断值 敏感度 特异度 95%CI sST2 0.753 0.044 < 0.001 74.135 0.800 0.603 0.667~0.838 Myo 0.816 0.041 < 0.001 169.290 0.783 0.806 0.736~0.896 IL-6 0.898 0.033 < 0.001 102.295 0.817 0.919 0.833~0.962 三者联合 0.936 0.020 < 0.001 — 0.883 0.855 0.893~0.979
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[1] GOLDSTEIN D, FRISHMAN W H. Diastolic heart failure: a review of current and future treatment options[J]. Cardiol Rev, 2021, 29(2): 82-88. doi: 10.1097/CRD.0000000000000303
[2] KIRKMAN D L, BOHMKE N, BILLINGSLEY H E, et al. Sarcopenic obesity in heart failure with preserved ejection fraction[J]. Front Endocrinol, 2020, 11: 558271. doi: 10.3389/fendo.2020.558271
[3] LV J Y, LI Y M, SHI S Q, et al. Skeletal muscle mitochondrial remodeling in heart failure: an update on mechanisms and therapeutic opportunities[J]. Biomedecine Pharmacother, 2022, 155: 113833. doi: 10.1016/j.biopha.2022.113833
[4] ZHANG H, HU W W, YUAN M X, et al. The association between erector spinae muscle content and chronic heart failure and its severity[J]. ESC Heart Fail, 2023, 10(5): 2982-2989. doi: 10.1002/ehf2.14482
[5] RABKIN S W, TANG J K K. The utility of growth differentiation factor-15, galectin-3, and sST2 as biomarkers for the diagnosis of heart failure with preserved ejection fraction and compared to heart failure with reduced ejection fraction: a systematic review[J]. Heart Fail Rev, 2021, 26(4): 799-812. doi: 10.1007/s10741-020-09913-3
[6] TANACLI R, HASHEMI D, NEYE M, et al. Multilayer myocardial strain improves the diagnosis of heart failure with preserved ejection fraction[J]. ESC Heart Fail, 2020, 7(5): 3240-3245. doi: 10.1002/ehf2.12826
[7] 马树灿, 李茹, 刘智芬, 等. 血清25(OH) D3、IL-6在老年冠心病并发衰弱综合征诊断中的价值[J]. 山东医药, 2022, 62(22): 24-28. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYY202222006.htm [8] 魏安华, 李娟. 《中国心力衰竭诊断和治疗指南2018》药物更新透视[J]. 医药导报, 2019, 38(5): 539-543. https://www.cnki.com.cn/Article/CJFDTOTAL-YYDB201905001.htm [9] GREENE S J, BUTLER J, SPERTUS J A, et al. Comparison of New York heart association class and patient-reported outcomes for heart failure with reduced ejection fraction[J]. JAMA Cardiol, 2021, 6(5): 522-531. doi: 10.1001/jamacardio.2021.0372
[10] 程蕊, 王晶, 张克英, 等. 2019亚洲肌少症诊断共识下肌少症相关危险因素评估[J]. 河北医科大学学报, 2021, 42(12): 1421-1425. doi: 10.3969/j.issn.1007-3205.2021.12.012 [11] 杨芮, 于俊民, 张小波, 等. 老年慢性心力衰竭心室重构相关分子机制的研究进展[J]. 实用临床医药杂志, 2023, 27(23): 139-143. doi: 10.7619/jcmp.20231891 [12] SCIATTI E, MERLO A, SCANGIUZZI C, et al. Prognostic value of sST2 in heart failure[J]. J Clin Med, 2023, 12(12): 3970. doi: 10.3390/jcm12123970
[13] LOTIERZO M, DUPUY A M, KALMANOVICH E, et al. sST2 as a value-added biomarker in heart failure[J]. Clin Chim Acta, 2020, 501: 120-130. doi: 10.1016/j.cca.2019.10.029
[14] PEREIRA S L, SHOEMAKER M E, GAWEL S, et al. Biomarker changes in response to a 12-week supplementation of an oral nutritional supplement enriched with protein, vitamin D and HMB in malnourished community dwelling older adults with sarcopenia[J]. Nutrients, 2022, 14(6): 1196. doi: 10.3390/nu14061196
[15] 贡歌, 万文辉, 刘新晖, 等. 高龄患者共病指数与肌少症的相关性研究[J]. 中华老年骨科与康复电子杂志, 2019, 5(6): 327-331. https://www.cnki.com.cn/Article/CJFDTOTAL-LNGK201906006.htm [16] HUO S Q, SHI W, MA H Y, et al. Alleviation of inflammation and oxidative stress in pressure overload-induced cardiac remodeling and heart failure via IL-6/STAT3 inhibition by raloxifene[J]. Oxid Med Cell Longev, 2021, 2021: 6699054.
[17] PROKOPIDIS K, ISANEJAD M, AKPAN A, et al. Exercise and nutritional interventions on sarcopenia and frailty in heart failure: a narrative review of systematic reviews and meta-analyses[J]. ESC Heart Fail, 2022, 9(5): 2787-2799. doi: 10.1002/ehf2.14052
[18] BANO G, TREVISAN C, CARRARO S, et al. Inflammation and sarcopenia: a systematic review and meta-analysis[J]. Maturitas, 2017, 96: 10-15. doi: 10.1016/j.maturitas.2016.11.006
[19] CANDIA A M, VILLACORTA H Jr, MESQUITA E T. Immune-inflammatory activation in heart failure[J]. Arq Bras Cardiol, 2007, 89(3): 183-190, 201-208.
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