Teplyakov A T, Berezikova E N, Shilov S N, Grakova E V, Torim Yu Yu, Efremov A V, Popova A A, Pustovetova M G, Sabirova A Yu, Kopyeva K V
FGBNU 'NII kardiologii', Tomsk, Rossija.
GBOU VPO 'Novosibirskij gosudarstvennyj meditsinskij universitet' Minzdrava Rossii, Novosibirsk, Rossija.
Ter Arkh. 2016;88(9):10-16. doi: 10.17116/terarkh201688910-16.
to reveal the specific features of Fas ligand-mediated ischemic myocardial remodeling and those of chronic heart failure (CHF) development during a 12-month prospective follow-up.
A total of 94 patients with ischemic CHF were examined and divided into 3 groups according to NYHA Functional Class (FC): 1) FC II CHF in 35 patients; 2) FC III CHF in 31; 3) FC IV CHF in 28. According to the results of the 12-month follow-up, the patients were randomized into 2 groups: A) 49 patients with a favorable course of cardiovascular disease and B) 45 patients with its poor course. Serum soluble Fas ligand (sFas-L) levels were measured by enzyme immunoassay.
In the patients with CHF, the baseline sFas-L levels substantially exceeded that in the control group by 3-6 times (p<0.01). In the men with the poor course of CHF, the baseline serum sFAS-L levels (85.94±4.14 pg/ml) were significantly higher than that in the favorable CHF group (107.33±5.13 pg/ml; р=0.0015). ROC analysis of the sensitivity and specificity of cardiovascular risk stratification according to sFAS-L levels revealed the high prognostic value of this marker - ROC-Area±S.E. was 0.75±0.05 (95% confidence interval, 0.60 to 0.81; p=0.0005). There was a statistically significant moderate correlation of left ventricular (LV) ejection fraction with sFAS-L concentrations and a moderate direct correlation between serum sFAS-L concentrations and LV remodeling parameters.
The serum level of sFas-L determines the development of ischemic LV remodeling and the severity of CHF, by increasing in proportion to the degree of disease progression. The determination of serum sFas-L levels assists in objectively estimating the severity of apoptosis and may be an important prognostic test to assess the course of CHF in patients with coronary heart disease.
揭示在12个月的前瞻性随访期间，Fas配体介导的缺血性心肌重塑的具体特征以及慢性心力衰竭（CHF）发展的特征。
共检查了94例缺血性CHF患者，并根据纽约心脏协会功能分级（FC）将其分为3组：1）35例FC II级CHF患者；2）31例FC III级CHF患者；3）28例FC IV级CHF患者。根据12个月的随访结果，将患者随机分为2组：A）49例心血管疾病病程良好的患者和B）45例心血管疾病病程不良的患者。采用酶免疫法测定血清可溶性Fas配体（sFas-L）水平。
CHF患者的基线sFas-L水平比对照组大幅高出3至6倍（p<0.01）。在CHF病程不良的男性患者中，基线血清sFAS-L水平（85.94±4.14 pg/ml）显著高于病程良好的CHF组（107.33±5.13 pg/ml；р=0.0015）。根据sFAS-L水平对心血管风险分层的敏感性和特异性进行的ROC分析显示，该标志物具有较高的预后价值——ROC曲线下面积±标准误为0.75±0.05（95%置信区间，0.60至0.81；p=0.0005）。左心室（LV）射血分数与sFAS-L浓度之间存在统计学上显著的中度相关性，血清sFAS-L浓度与LV重塑参数之间存在中度正相关。
血清sFas-L水平决定了缺血性LV重塑的发展以及CHF的严重程度，其水平与疾病进展程度成比例增加。测定血清sFas-L水平有助于客观评估细胞凋亡的严重程度，可能是评估冠心病患者CHF病程的一项重要预后检测指标。
