血清热休克蛋白27及其磷酸化与急性心力衰竭患者预后的关系

Predictive value of serum heat shock protein 27 and its phosphorylation on the prognosis of patients with acute heart failure

    摘要
  • 摘要:
    目的 探讨血清热休克蛋白27（HSP27）、磷酸化热休克蛋白27（pHSP27）与急性心力衰竭患者预后的关系。
    方法 纳入2020年12月至2021年6月就诊于福建省立医院心血管内科的患者178例，其中对照组40例，急性心力衰竭组138例。采用酶联免疫吸附试验法测定血清HSP27、pHSP27水平，随访观察近期主要不良心血管事件（MACE，包括不稳定型心绞痛、心力衰竭再入院、急性心肌梗死、脑卒中、死亡）的发生情况。分析HSP27、pHSP27与MACE的关系。
    结果 急性心力衰竭患者血清HSP27、pHSP27水平均高于对照组（P＜0.05）。对纳入的138例急性心力衰竭患者进行随访，随访时间中位数（P25，P75）为9（6，12）月，共有30例出现MACE，其中不稳定型心绞痛10例、心力衰竭再入院13例、脑卒中2例，死亡5例。受试者操作特征（ROC）曲线分析结果显示，血清HSP27、pHSP27及两者联合均对急性心力衰竭患者MACE的发生有一定预测价值，曲线下面积（95%CI）分别为0.634（0.524～0.745）、0.656（0.534～0.779）、0.720（0.611～0.829）。多因素Cox回归分析发现，校正性别、年龄、嗜酸性粒细胞计数、血小板计数及氨基末端脑利尿钠肽前体（NT-proBNP）后，高HSP27（HR=1.009，95%CI 1.003～1.016）、pHSP27（HR=1.078，95%CI 1.037～1.139）是发生MACE的独立危险因素。Kaplan-Meier分析发现，高水平HSP27、pHSP27组MACE发生时间较低水平HSP27、pHSP27组明显提早，累积存活时间较低水平组短（Log-rank检验，χ2=6.915, P=0.009；χ2=13.760, P＜0.001）。
    结论 急性心力衰竭患者血清HSP27、pHSP27水平均明显升高。高水平HSP27及pHSP27与不良预后的发生密切相关。

     

    Abstract:
    Objective To explore the relationship between serum heat shock protein 27 (HSP27) and phosphorylated HSP27 (pHSP27) on the prognosis of patients with acute heart failure.
    Methods A total of 178 patients who visited the Department of Cardiology of Fujian Provincial Hospital from December 2020 to June 2021 were included, including 40 patients in the control group and 138 patients in the acute heart failure group. The levels of serum HSP27 and pHSP27 were measured by enzyme-linked immunosorbent assay. The occurrence of recent major adverse cardiovascular events (MACE), including unstable angina, rehospitalization for heart failure, acute myocardial infarction, stroke, death, was observed during follow-up. The relationships of HSP27 and pHSP27 with MACE were analyzed.
    Results The levels of serum HSP27 and pHSP27 in patients with acute heart failure were higher than those in the control group (P＜0.05). A total of 138 patients with acute heart failure were followed up for a median of 9 (P25, P75 6, 12) months. A total of 30 patients developed MACE, including 10 cases of recurrent angina, 13 cases of rehospitalization for heart failure, 2 cases of stroke, and 5 deaths. The results of receiver operating characteristic (ROC) curve analysis showed that serum HSP27, pHSP27 and their combination could predict the occurrence of MACE in patients with acute heart failure, with the area under the curve (95%CI) being 0.634 (0.524–0.745), 0.656 (0.534–0.779), and 0.720 (0.611–0.829), respectively. After adjusted for gender, age, eosinophil count, platelet count, and N-terminal pro-brain natriuretic peptide (NT-proBNP), multivariate Cox regression analysis showed that high HSP27 (HR=1.009, 95%CI 1.003–1.016) and pHSP27 (HR=1.078, 1.037–1.139) were independent risk factors for MACE. Kaplan-Meier analysis showed that the time of MACE occurrence in the high-level HSP27 and pHSP27 groups was significantly earlier than that in the low-level HSP27 and pHSP27 groups, and the cumulative survival time was shorter in the low-level group (Log-rank, χ2=6.915, P=0.009; χ2=13.760, P＜0.001).
    Conclusions Serum HSP27 and pHSP27 levels are significantly increased in patients with acute heart failure. High levels of HSP27 and its phosphorylation are closely related to the occurrence of poor prognosis.

     

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