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血清内皮细胞特异性分子1水平与肝硬化心肌病的相关性

马丽霞 韦新焕 曹振环 张晶

引用本文:
Citation:

血清内皮细胞特异性分子1水平与肝硬化心肌病的相关性

DOI: 10.12449/JCH240614
基金项目: 

北京市属医院科研培育计划项目 (PX2024061)

伦理学声明: 本研究方案于2020年6月15日经由首都医科大学附属北京佑安医院伦理委员会审批,批号:LL-2020-068-K,所纳入患者均签署知情同意书。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:马丽霞、张晶负责课题设计,资料分析,撰写论文;马丽霞、韦新焕参与收集数据,修改论文;曹振环、张晶负责拟定写作思路,指导撰写文章并最后定稿。
详细信息
    通信作者:

    张晶, drzhangjing@163.com (ORCID: 0000-0002-3082-8330)

Association between serum endothelial cell-specific molecule 1 and cirrhotic cardiomyopathy

Research funding: 

Beijing Municipal Administration of Hospitals Incubating Program (PX2024061)

More Information
  • 摘要:   目的  肝硬化性心肌病(CCM)是肝硬化引起的心脏功能障碍和电生理紊乱,与肝硬化患者预后密切相关。血管内皮细胞特异性分子1(endocan)作为心血管疾病的诊断指标,是否参与CCM发病机制尚不明确。本研究拟检测CCM患者血清endocan的表达量及其与CCM的关系,推测在CCM发病中的可能作用。  方法  本研究为横断面研究,连续入组2019年1月—2021年1月首都医科大学附属北京佑安医院住院的肝硬化患者,根据有无CCM,分为CCM组(n=19)和无CCM组(n=106)。采用ELISA方法检测不同组血清endocan水平以及与肝功能、心脏功能的相关性。正态分布的计量资料两组间比较采用成组t检验,偏态分布的计量资料两组间比较采用Mann-Whitney U秩和检验。计数资料组间比较采用χ2检验。采用Pearson或Spearman相关分析进行相关性检验,应用受试者工作特征曲线(ROC曲线)评价CCM预测模型。  结果  CCM组患者血清endocan的表达量为[(2.69±0.43)ng/mL]明显高于无CCM组[(2.23±0.52)ng/mL](t=2.247,P=0.034)。在代偿期肝硬化患者血清endocan表达量[(2.41±0.37)ng/mL]显著低于失代偿期肝硬化组[(2.72±0.49)ng/mL](t=3.214,P=0.02)。CCM组患者血清endocan水平与肝功能Child-Pugh评分(r=0.509,P=0.026)、MELD-Na评分(r=0.484,P=0.036)呈正相关,与平均动脉压(r=-0.591,P=0.013)、二尖瓣舒张早期血流早峰值E波和舒张晚期血流峰值A波(E/A)比值(r=-0.515,P=0.042)呈负相关。血清endocan预测CCM的ROC曲线下面积为0.658(95%CI:0.522~0.781),当截断值为2.61 ng/mL时,敏感度为67.1%,特异度为73.7%。  结论  血清endocan与CCM的发生具有一定相关性,可能参与了CCM的发病机制。

     

  • 图  1  血清endocan预测CCM的ROC曲线

    Figure  1.  Serum endocan predicted ROC curve of CCM

    表  1  肝硬化CCM组及无CCM组患者一般资料比较

    Table  1.   Comparison of general data between CCM and no-CCM

    项目 CCM组(n=19) 无CCM组(n=106) 统计值 P
    男性[例(%)] 12(63.2) 71(67.0) χ2=2.834 0.632
    年龄(岁) 58.0±9.1 56.2±8.8 t=0.536 0.335
    肝硬化病因[例(%)] χ2=2.534 0.894
    HBV 5(26.3) 36(34.0)
    HCV 9(47.4) 42(39.6)
    原发性胆汁性胆管炎 1(5.3) 6(5.7)
    药物性肝损伤 4(21.1) 22(20.8)
    平均动脉压(mmHg) 89.7±11.0 87.0±9.8 t=0.043 0.291
    心率(次/min) 76.3±13.9 76.3±13.8 t=0.125 0.993
    Child-Pugh分级[例(%)] χ2=-2.134 0.172
    A级 12(63.2) 50(47.2)
    B级 4(21.1) 39(36.8)
    C级 3(15.8) 17(16.0)
    MELD评分(分) 6(5~7) 6(5~10) Z=-3.345 0.593
    MELD-Na评分(分) 8.1(5.1~10.2) 7.5(4.7~11.2) Z=-1.236 0.744
    ALT(U/L) 39.1(29.5~57.1) 25.8(15.4~38.5) Z=-0.232 0.552
    AST(U/L) 29.0(25.8~84.0) 39.1(29.2~57.1) Z=-0.134 0.361
    白蛋白(g/L) 31.4±0.5 31.8±0.2 t=0.123 0.762
    总胆红素(μmol/L) 25.9(18.4~33.7) 31.9(17.9~50.0) Z=-1.207 0.335
    肌酐(μmol/L) 59.3±0.5 62.1±0.23 t=0.042 0.553
    尿素氮(mmol/L) 4.4(3.8~5.7) 5.2(4.1~6.3) Z=-1.356 0.191
    国际标准化比值 1.2(1.1~1.5) 13.(1.2~1.5) Z=-2.237 0.493
    腹水[例(%)] 8(42.1) 64(60.4) χ2=0.018 0.227
    自发性腹膜炎[例(%)] 3(15.8) 13(12.3) χ2=0.346 0.961
    肝性脑病[例(%)] 1(5.3) 14(13.2) χ2=1.235 0.554
    食管静脉曲张[例(%)] 10(52.6) 70(66.0) χ2=0.234 0.397
    胃静脉曲张[例(%)] 6(31.6) 44(41.5) χ2=0.156 0.571
    门静脉内径(mm) 13(11~15) 13(12~14) Z=-1.239 0.857
    脾静脉内径(mm) 8(7~12) 10(8~12) Z=-1.670 0.144
    脾脏厚度(mm) 45.0±10.3 54.0±14.2 t=0.126 0.051
    白细胞(×109/L) 3.52(1.94~4.97) 3.99(2.24~5.23) Z=-0.467 0.633
    血红蛋白(g/L) 106.2±32.2 98.0±33.4 t=0.114 0.621
    血小板(×109/L) 74(48~129) 64(39~99) Z=-0.674 0.820
    血钠(mmol/L) 138.0±3.6 138.0±3.7 t=0.047 0.814
    血钾(mmol/L) 3.9(3.3~4.1) 3.8(3.5~4.1) Z=-1.345 0.886
    总胆固醇(mmol/L) 2.9±1.2 3.1±0.9 t=0.124 0.651
    甘油三酯(mmol/L) 0.8(0.6~1.1) 0.8(0.6~1.0) Z=-0.736 0.392
    NT-proBNP(pg/mL) 220(160~250) 119(108~160) Z=-3.028 <0.001
    cTNI(ng/mL) 0.27(0.21~0.28) 0.27(0.27~0.28) Z=-1.239 0.937
    使用利尿剂[例(%)] 8(42.1) 59(55.7) χ2=0.876 0.404
    下载: 导出CSV

    表  2  肝硬化CCM组及无CCM组患者超声心动图和心电图各指标比较

    Table  2.   Comparison of echocardiography and electrocardiogram parameters between CCM and no-CCM

    参数 CCM组(n=19) 无CCM组(n=106) 统计值 P
    QT间期(ms) 397.1±31.1 398.2±31.7 t=0.053 0.832
    E/A比值 0.76(0.63~0.88) 0.98(0.77~1.30) Z=-5.789 <0.001
    左心室射血分数(%) 54.2±7.8 68.3±6.6 t=1.146 0.011
    左心房内径(mm) 34.6±4.5 34.5±5.1 t=0.347 0.963
    左心室舒张末内径(mm) 48.3±6.7 47.9±5.4 t=0.089 0.744
    左心室收缩末内径(mm) 32.2±7.5 29.1±4.5 t=0.157 0.096
    左室短轴缩短率(%) 34.3±5.7 39.8±4.5 t=3.248 <0.001
    左心室后壁厚度(mm) 10.1±1.7 8.9±1.5 t=1.324 0.064
    室间隔厚度(mm) 11.2(9.2~11.4) 10.6(9.3~11.6) Z=-1.663 0.161
    下载: 导出CSV
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  • 收稿日期:  2023-12-26
  • 录用日期:  2024-02-08
  • 出版日期:  2024-06-25
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