Serum retinol-binding protein 4 as a predictor of cardiovascular events in elderly patients with chronic heart failure
Serum retinol-binding protein 4 as a predictor of cardiovascular events in elderly patients with chronic heart failure
复制标题
血清视黄醇结合蛋白4作为老年慢性心力衰竭患者心血管事件的预测因子
DOI：
10.1002/ehf2.12591
复制
发表时间：
2020-01-21
影响因子：
3.8
通讯作者：
Lu, Xiang
中科院分区：
文献类型：
--
作者：
Li, Xiu-Zhen;Zhang, Kang-Zhen;Lu, Xiang
目的RBP4是一种对心血管系统有不良影响的脂肪因子。循环中视黄醇结合蛋白4(RBP4)的增加与慢性心力衰竭(CHF)有关。然而，RBP4升高是否与老年充血性心力衰竭患者预后不良相关尚不清楚。本研究的目的是评价血清RBP4在老年CHF患者中的预后价值。方法和结果在前瞻性队列研究中，我们招募了934名60岁以上的老年CHF患者和138名年龄匹配和性别匹配的对照组，并用多因素COX回归分析探讨了血清RBP4水平与临床预后的关系。CHF患者血清RBP4水平明显高于对照组(46.66+/-12.38mU/mLvs.40.71+/-7.2mU/mLP<；0.001)。RbP4浓度最高的患者N末端脑利钠肽原水平较高，而左心室射血分数和估计肾小球滤过率较低(P<；0.001)。血清RBP4水平随纽约心脏协会功能分级的增加而升高(P<；0.001)，与LVEF呈负相关(r=-0.154，P<；0.001)，与NT-proBNP水平呈正相关(r=0.074，P=0.023)。多因素COX回归分析显示，LogRBP4是主要不良心脏事件(S)的独立预测因子[危险比(HR)=2.61，95%可信区间(CI)=1.19~5.70]，与年龄、男性、LVEF、LOG NT-ProBNP和估计的肾小球滤过率有关。此外，LOG RBP4也是心血管死亡率(HR=2.24，95%CI=1.35-5.39)和CHF再住院(HR=2.54，95%CI=1.09-5.60)的独立预测因子，即使在调整了已建立的CHF不良预后因素后也是如此。Kaplan-Meier生存曲线显示，高浓度的RBP4是CHF患者主要不良心脏事件(S)的预后指标。结论首次证实血清RBP4升高与老年CHF患者预后不良相关。
Aims RBP4 is an adipokine with adverse effects on cardiovascular system. Increased circulating retinol-binding protein 4 (RBP4) has been linked to chronic heart failure (CHF). However, whether elevated RBP4 is correlated with a poor prognosis in elderly patients with CHF remains unclear. The aim of this study was to evaluate the prognostic value of serum RBP4 in elderly patients with CHF. Methods and results We enrolled 934 consecutive elderly patients (aged 60 years and older) with CHF and 138 age-matched and sex-matched control subjects in a prospective cohort study and explored the association of serum RBP4 levels with the clinical outcomes using multivariate Cox regression analyses. Serum RBP4 levels were elevated in CHF patients when compared with controls (46.66 +/- 12.38 mu g/mL vs. 40.71 +/- 7.2 mu g/mL, P < 0.001). Patients with the highest RBP4 concentrations had higher N terminal pro brain natriuretic peptide (NT-proBNP) levels but lower left ventricular eject fraction (LVEF) and estimated glomerular filtration rate (P < 0.001). Serum RBP4 levels were increased as the New York Heart Association functional class increased and LVEF decreased (P < 0.001) and were negatively correlated with LVEF (r = -0.154, P < 0.001) but positively correlated with NT-proBNP levels (r = 0.074, P = 0.023). Multivariate Cox regression analysis suggested that log RBP4 was an independent predictor for major adverse cardiac event(s) [hazard ratio (HR) = 2.61, 95% confidence interval (CI) = 1.19-5.70], together with age, male, LVEF, log NT-proBNP, and estimated glomerular filtration rate. Moreover, log RBP4 was also an independent predictor for cardiovascular mortality (HR = 2.24, 95% CI = 1.35-5.39) and CHF rehospitalization (HR = 2.54, 95% CI = 1.09-5.60) even after adjustment for the established adverse prognostic factors for CHF. The Kaplan-Meier survival curves showed that high concentration of RBP4 was a prognostic indicator of major adverse cardiac event(s) in patients with CHF. Conclusions Our findings demonstrate for the first time that elevated serum RBP4 is correlated with worse outcome in elderly patients with CHF.