Biomarkers of myocardial stress and systemic inflammation in patients who engage in heart failure self-care management.
Biomarkers of myocardial stress and systemic inflammation in patients who engage in heart failure self-care management.
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DOI：
10.1097/jcn.0b013e31820344be
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发表时间：
2011-07
期刊：
影响因子：
--
通讯作者：
Riegel B
中科院分区：
文献类型：
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作者：
Lee CS;Moser DK;Lennie TA;Tkacs NC;Margulies KB;Riegel B
自我保健被认为可以改善心力衰竭（HF）的结果，但这种改善发生的机制仍不清楚。我们完成了对有症状的心力衰竭成人的横断面数据的二次分析，以检验我们的假设，即有效的自我护理与减少心肌应激和全身炎症有关。使用多变量逻辑回归模型来确定更好的心力衰竭自我护理是否会降低 NT proBNP 和 1 型可溶性 TNFα 受体血清水平等于或高于样本中位数的几率。使用心力衰竭自我护理指数来衡量心力衰竭自我护理。样本 (n=168) 主要为男性 (65.5%)，大多数 (50.6%) 患有 NYHA III HF（平均 LVEF= 34.9%±14.0%）；平均年龄为 58.8±11.5 岁。在控制相关混杂因素（模型 χ2 =52.15，p<.001）后，自我护理管理是模型中的一个独立因素（块 χ2 =14.74，p=.005）。自我保健管理得分（范围 15-100）每增加 1 分，两种生物标志物达到或高于样本中位数的几率就会降低 12.7%（调整后的优势比 =0.873，95% CI=0.77-0.99，p=.03）。与药物治疗和其他常见混杂因素相比，更好的自我护理管理与降低心肌应激和全身炎症的发生率相关。教导心力衰竭患者早期症状识别和症状自我护理可能会减少心肌应激和全身炎症。
Self-care is believed to improve heart failure (HF) outcomes, but the mechanisms by which such improvement occurs remain unclear. We completed a secondary analysis of cross-sectional data collected on adults with symptomatic HF to test our hypothesis that effective self-care is associated with less myocardial stress and systemic inflammation. Multivariate logistic regression modeling was used to determine if better HF self-care reduced the odds of having serum levels of NT proBNP and soluble TNFα receptor type 1 at or above the sample median. HF self-care was measured using the Self-Care of Heart Failure Index. The sample (n=168) was predominantly male (65.5%) and most (50.6%) had NYHA III HF (mean LVEF= 34.9%±14.0%); mean age was 58.8±11.5 years. Self-care management was an independent factor in the model (block χ2 =14.74, p=.005) after controlling for pertinent confounders (model χ2 =52.15, p<.001). Each one-point increase in self-care management score (range 15–100) was associated with a 12.7% reduction in the odds of having both biomarkers at or above the sample median (adjusted odds ratio =0.873, 95% CI=0.77–0.99, p=.03). Better self-care management was associated with reduced odds of myocardial stress and systemic inflammation over and above pharmacologic therapy and other common confounding factors. Teaching HF patients early symptom recognition and self-care of symptoms may decrease myocardial stress and systemic inflammation.