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.

Objective To observe the effects of atorvastatin on the level of blood lipid and cardiac events in patients with coronary heart disease after percutaneous coronary intervention (PCI). Methods One hundred and twenty - six patients with coronary heart disease after PCI were randomly administered atorvastatin 10mg/d( group A, n = 64)or 20 mg/d( group B, n =62)for 12 month. The blood lipid was measured and cardiac events were observed. Results The level of total cholesterol( TC), triglyceride( TG), low density lipoprotein -cholesterol (LDL- C) decreased significantly in both groups ( P <0. 05 ). There were significant differences between the two groups in the level of TC, LDL and CRP( P <0. 05 ), but no difference in the occurrence of cardiac events. Conclusions Atorvastatin can prevent patients with coronary heart disease after PCI from restenosis. The prevention effect of atrovastatin 20 mg daily is better than 10 mg daily.