目的 探讨射血分数保留的心力衰竭(HFpEF)患者血清血小板吸附蛋白2(TSP-2)、可溶性AXL(sAXL)、生长分化因子15(GDF-15)水平与病情严重程度的关系,并探讨三者对HFpEF的诊断价值.方法 选择2017年3月至2019年8月收治的152例HFpEF患者(HFpEF组)和100例门诊体检的健康志愿者(对照组).采用酶联免疫吸附试验检测血清TSP-2、sAXL、GDF-15水平,分析TSP-2、sAXL、GDF-15与HFpEF患者美国纽约心脏病协会(NYHA)心功能分级、血清N末端B型利钠肽原(NT-proBNP)水平、左心室射血分数(LVEF)、左心房内径(LAD)、舒张末期左心室内径(LVEDD)的相关性.受试者工作特征曲线(ROC)分析TSP-2、sAXL、GDF-15诊断HFpEF的价值.结果 HFpEF组血清TSP-2、sAXL、GDF-15、NT-proBNP水平、LAD、LVEDD高于对照组(P<0.05),LVEF低于对照组(P<0.05).血清TSP-2、sAXL、GDF-15水平随着HFpEF患者NYHA心功能分级的增加而升高(P<0.05).相关性分析结果显示血清TSP-2、sAXL、GDF-15与HFpEF患者NYHA心功能分级、血清NT-proBNP水平均呈正相关(rs=0.462、0.406、0.564;r=0.512、0.535、0.515;P<0.05).ROC分析结果显示TSP-2、sAXL、GDF-15、TSP-2+sAXL+GDF-15诊断HFpEF的曲线下面积(AUC)分别为0.715(95％CI:0.649～0.782)、0.713(95％CI:0.648～0.778)、0.750(95％CI:0.690～0.811)、0.926(95％CI:0.891～0.960),灵敏度分别为71.05％、73.68％、67.11％、92.76％,特异度分别为71.00％、69.00％、75.00％、89.00％.结论 HFpEF患者TSP-2、sAXL、GDF-15水平明显升高,TSP-2、sAXL、GDF-15水平与HFpEF患者病情严重程度密切相关,可能作为HFpEF诊断和病情评估的辅助指标.

Background: The K+ channel, subfamily J, member-11 (KCNJ11) E23K and b1 subunit of large-conductance Ca2+-activated K+ channel (KCNMB1) E65K polymorphisms were shown to be associated with the risk of essential hypertension (EH). However, the results were inconclusive with relatively small sample size. Thus, we carried out a meta-analysis to investigate the genetic association between KCNJ11 E23K and KCNMB1 E65K polymorphisms and essential hypertension risk. Methods: Relative studies were collected using PubMed, Web of Science, the Cochrane Library databases, Chinese National Knowledge Infrastructure and Embase databases. Pooled odds ratios with 95% confidence intervals were used to assess the strength of associations. Results: The dominant models of KCNJ11 E23K (P=.006, OR [95% CI]=0.45 [0.25, 0.79]) and KCNMB1 E65K (P=.04, OR [95% CI]=0.91 [0.83, 1.00]) were significantly associated with essential hypertension risk. No significant association was detected between the allelic and recessive models of KCNJ11 E23K and KCNMB1 E65K and the susceptibility of EH. Subgroup analysis stratified by ethnicity showed that the dominant model of KCNMB1 E65K was associated with EH risk in Asian population (P=.003, OR [95% CI]=0.83 [0.74, 0.94]), but not in Caucasian (P=.74, OR [95% CI]=1.02 [0.89, 1.18]). Conclusions: The dominant model of KCNJ11 E23K and KCNMB1 E65K might be susceptible factors for essential hypertension. To confirm this result, large-scale case-control studies with more subjects are necessary.

Abstract Background: The K+ channel, subfamily J, member-11 (KCNJ11) E23K and β1 subunit of large-conductance Ca2+-activated K+ channel (KCNMB1) E65K polymorphisms were shown to be associated with the risk of essential hypertension (EH). However, the results were inconclusive with relatively small sample size. Thus, we carried out a meta-analysis to investigate the genetic association between KCNJ11 E23K and KCNMB1 E65K polymorphisms and essential hypertension risk. Methods: Relative studies were collected using PubMed, Web of Science, the Cochrane Library databases, Chinese National Knowledge Infrastructure and Embase databases. Pooled odds ratios with 95% confidence intervals were used to assess the strength of associations. Results: The dominant models of KCNJ11 E23K (P = .006, OR [95%CI] = 0.45 [0.25, 0.79]) and KCNMB1 E65K (P = .04, OR [95%CI] = 0.91 [0.83, 1.00]) were significantly associated with essential hypertension risk. No significant association was detected between the allelic and recessive models of KCNJ11 E23K and KCNMB1 E65K and the susceptibility of EH. Subgroup analysis stratified by ethnicity showed that the dominant model of KCNMB1 E65K was associated with EH risk in Asian population (P = .003, OR [95%CI] = 0.83 [0.74, 0.94]), but not in Caucasian (P = .74, OR [95%CI] = 1.02 [0.89, 1.18]). Conclusions: The dominant model of KCNJ11 E23K and KCNMB1 E65K might be susceptible factors for essential hypertension. To confirm this result, large-scale case-control studies with more subjects are necessary.

1 病史摘要 患者,女性,64岁.因"反复胸闷7年,加重3天"门诊入院.既往有高脂血症史,否认高血压及糖尿病史.否认嗜烟酒史,已绝经10余年.查体:神清,血压110/70 mm Hg,体温36.5度,呼吸18次/分.心界无扩大,心率85次/分,律齐,各瓣膜区未闻及杂音.两肺呼吸音粗,未闻及明显干湿啰音.双下肢无水肿.辅助检查:心电图示窦律、非特异性ST-T改变;血脂示甘油三酯2.93 mmol/L、胆固醇7.9 mmol/L;心超示静息状态下未见明显异常;行冠脉造影提示右冠未见明显狭窄,左前降支近中端第一对角支开口处70%狭窄,内附有血栓,致血流明显变缓.左回旋支可见散在斑块,可见40%～50%狭窄,未做特殊处理.但术后当天发现右腹股沟穿刺处一小血肿约2.0 cm×2.0 cm,已予沙袋加压包扎6小时.术后4天患者诉右大腿根部胀痛伴行走时不适,血肿范围扩大,周围皮肤青紫,听诊可闻及杂音,足背动脉搏动良好.术后诊断:1、冠心病,不稳定性心绞痛,心功能Ⅱ级; 2、高脂血症;3、股动脉假性动脉瘤,予加强抗栓抗缺血治疗(拜阿司匹林+氯吡格雷+法安明,异舒吉),同时行B超检查.