血清降钙素原、心肌肌钙蛋白Ⅰ和胆碱酯酶的表达与老年慢性心力衰竭合并肺部感染患者病情及预后的相关性分析

Association of serum procalcitonin,cardiac troponin Ⅰ,and cholinesterase with disease severity and prognosis in elderly patients with chronic heart failure and pulmonary infection

中文关键词: 老年    慢性心力衰竭    肺部感染    降钙素原    心肌肌钙蛋白Ⅰ    胆碱酯酶类

英文关键词: elderly  chronic heart failure  pulmonary infection  procalcitonin  cardiac troponin Ⅰ  cholinesterases

中文摘要:

      目的 探讨老年慢性心力衰竭(CHF)合并肺部感染(PI)患者血清降钙素原(PCT)、心肌肌钙蛋白Ⅰ(cTnⅠ)、胆碱酯酶(ChE)表达与病情及预后的相关性。方法 收集2023年7月至2024年7月于石家庄市第三医院接受治疗的224例老年CHF合并PI患者作为研究组，收集同期224例单纯老年CHF患者作为对照组。研究组根据临床PI评分分为轻度组(n=71)、中度组(n=98)和重度组(n=55);根据纽约心脏病协会(NYHA)心功能分级分为Ⅱ级(n=92)、Ⅲ级(n=79)和Ⅳ级(n=53);根据28 d生存情况分为预后良好组(n=151)和预后不良组(n=73)。多因素Logistic回归模型分析老年CHF合并PI患者预后的影响因素；采用受试者操作特征(ROC)曲线评估PCT、cTnⅠ、ChE对老年CHF合并PI患者预后的预测价值。结果 与对照组相比，研究组血清PCT、cTnⅠ水平较高，ChE水平较低，差异有统计学意义(P<0.05)。患者血清PCT、cTnⅠ水平随PI严重程度和NYHA心功能分级逐渐上升，血清ChE水平随PI严重程度和NYHA心功能分级下降(P<0.05)。与预后良好组相比，预后不良组NYHA心功能分级Ⅲ～Ⅳ级、糖尿病、吸烟史、合并呼吸道疾病构成比较高，血清PCT、cTnⅠ水平较高，血清ChE水平较低(P<0.05)。NYHA心功能Ⅲ～Ⅳ级，合并糖尿病、呼吸道疾病，血清PCT和cTnⅠ水平升高是老年CHF合并PI患者预后的危险因素；血清ChE水平升高是老年CHF合并PI患者预后的保护因素(P<0.05)。血清PCT、cTnⅠ和ChE对老年CHF合并PI患者预后的曲线下面积(AUC)分别为0.759、0.787、0.775,三者联合预测的AUC为0.939,三者联合检测优于任一项指标单独检测(P<0.05)。结论 老年CHF合并PI患者血清PCT、cTnⅠ水平上升，ChE水平下降，三者联合检测对老年CHF合并PI预后预测效能较好。

英文摘要:

      Objective To explore the correlation between serum procalcitonin(PCT),cardiac troponin Ⅰ(cTnⅠ),and cholinesterase(ChE)expression and clinical status,prognosis in elderly patients with chronic heart failure(CHF)complicated by pulmonary infection(PI).Methods Clinical data were collected from 224 elderly patients with CHF complicated by PI who received treatment in the Third Hospital of Shijiazhuang from July 2023 to July 2024,serving as the study group.These patients were categorized into mild(n=71),moderate(n=98),and severe(n=55)groups based on clinical PI scores,according to the New York Heart Association(NYHA)functional classification criteria,patients were classified into grade Ⅱ(92 cases),grade Ⅲ(79 cases),and grade IV(53 cases).Based on the survival status of 28 days,patients were stratified into good(n=151)and poor(n=73)prognosis group.In addition,224 elderly patients with simple CHF were included as the control group during the same period of the study.A multifactorial Logistic regression model was used to analyze the factors influencing the prognosis of elderly CHF patients with PI;the predictive value of PCT,cTnⅠ,and ChE for the prognosis of elderly CHF patients with PI was assessed using receiver operator characteristic curves.Results Compared with the control group,the serum PCT and cTnⅠ levels in the study group increased,while ChE levels decreased(P<0.05).The serum PCT and cTnⅠ levels gradually increased and ChE levels gradually decreased in mild,moderate,severe,and grade Ⅱ,Ⅲ,andⅣpatients.Compared with the good prognosis group,the poor prognosis group had a higher proportion of patients with smoking history,diabetes,combined respiratory diseases,and cardiac function grades ofⅢand Ⅳ(P<0.05).The serum PCT and cTnⅠ levels increased,and the ChE level decreased(P<0.05).NYHA heart function Ⅲ-Ⅳ,combined with diabetes and respiratory diseases,and elevated serum levels of PCT and cTnⅠ were independently associated with poorer prognosis in this cohort of elderly patients with CHF and PI,while elevated serum ChE levels are protective factors for the prognosis of elderly patients with CHF and PI(P<0.05).According to the ROC curve,the AUC values of serum PCT,cTnⅠ,and ChE for predicting the prognosis of elderly CHF patients with PI are 0.759,0.787,and 0.775,respectively.The AUC value predicted by the combination of the three is 0.939,and the combined detection of the three is better than the detection of any indicator alone(P<0.05).Conclusion The levels of PCT and cTnⅠin the serum of elderly CHF patients with PI increase,while the level of ChE decreases.The combination of the three factors has a better predictive effect on the prognosis of elderly CHF patients with PI.