Department of Cardiology, Herlev University Hospital, Herlev Ringvej 75, Herlev, Denmark.
Eur J Heart Fail. 2012 Apr;14(4):387-94. doi: 10.1093/eurjhf/hfs021. Epub 2012 Feb 22.
α-Defensins are part of the innate immune system. Low-grade inflammation seems to play a crucial role in development and progression of chronic heart failure (CHF). The aims of the present study were to compare plasma levels of α-defensins in CHF patients and healthy controls and to examine the predictive ability of α-defensins, alone and combined with N-terminal pro brain natriuretic peptide (NT-proBNP), with respect to all-cause mortality.
In a prospective observational study lasting 2.6 years we examined the prognostic value of plasma α-defensins with respect to mortality in 194 CHF patients, and compared plasma levels with those of 98 age-matched healthy controls. α-Defensin levels were twice as high among CHF patients in New York Heart Association (NYHA) functional class III-IV than in patients in NYHA class I-II and healthy controls (P = 0.001). The absolute increase in risk of mortality for patients with α-defensin levels in the upper tertile vs. the lowest tertile was 30% (P = 0.002). After adjusting for potential confounders including NT-proBNP, plasma α-defensins remained independently associated with an increased risk of all-cause mortality (hazard ratio 1.65, 95% confidence interval 1.19-2.28, P = 0.002) per 1 standard deviation increment in Ln (natural logarithm)-transformed α-defensin values. The combination of high α-defensins and NT-proBNP levels provided incremental prognostic information independent of well-known prognostic biomarkers in heart failure.
Plasma α-defensins appear to have prognostic information regarding mortality among patients with CHF and seem to provide incremental information to established clinical risk markers.
α-防御素是先天免疫系统的一部分。低水平炎症似乎在慢性心力衰竭（CHF）的发展和进展中起着至关重要的作用。本研究的目的是比较 CHF 患者和健康对照者的血浆 α-防御素水平，并单独和联合 N 末端脑钠肽前体（NT-proBNP）检查 α-防御素对全因死亡率的预测能力。
在一项持续 2.6 年的前瞻性观察研究中，我们检查了血浆 α-防御素对 194 例 CHF 患者死亡率的预后价值，并将其血浆水平与 98 名年龄匹配的健康对照者进行了比较。与 NYHA 心功能 I-II 级患者和健康对照组相比，NYHA 心功能 III-IV 级的 CHF 患者的 α-防御素水平高两倍（P = 0.001）。与最低三分位相比，α-防御素水平在上三分位的患者死亡风险绝对增加 30%（P = 0.002）。在调整了包括 NT-proBNP 在内的潜在混杂因素后，血浆 α-防御素仍然与全因死亡率增加独立相关（风险比 1.65，95%置信区间 1.19-2.28，P = 0.002）。ln（自然对数）变换后α-防御素值每增加 1 个标准差，独立于心力衰竭的已知预后生物标志物，风险增加 1.65 倍。高 α-防御素和 NT-proBNP 水平的组合提供了独立于既定临床风险标志物的增量预后信息。
血浆 α-防御素似乎对 CHF 患者的死亡率具有预后信息，并且似乎为既定的临床风险标志物提供了增量信息。
