热休克蛋白 27 可作为慢性心力衰竭患者预后的预测因子。
Heat shock protein 27 acts as a predictor of prognosis in chronic heart failure patients.
机构信息
Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Division of Cardiology, General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, 9000 Murska Sobota, Slovenia; Faculty of Medicine, University of Ljubljana, Korytkova ulica 2, 1000 Ljubljana, Slovenia.
出版信息
Clin Chim Acta. 2017 Oct;473:127-132. doi: 10.1016/j.cca.2017.08.028. Epub 2017 Aug 24.
BACKGROUND
Heat shock proteins (HSPs) represent intracellular mechanisms of stress response. Clinical implications of their (systemic) expression in patients with chronic heart failure (HF) remain inconclusive.
METHODS
In outpatients with chronic stable HF plasma HSP27 levels were measured using ELISA. Patients were followed for a minimum of one year, and a multivariate Cox proportional hazard model was built for cardiovascular death or HF-associated hospitalisations.
RESULTS
A total of 134 patients with chronic HF (mean age 71±10years, 34% female, mean LVEF 36±12%) were included. During a mean follow-up of 527±260days, 44 patients (33%) experienced an event. Mean time to event was 350±236days. In a Kaplan-Meier survival analysis HSP27 levels above the median (3820pg/ml) indicate a higher risk for an event (p=0.03). Increased HSP27 levels remained an independent predictor of events (HR, 2.33 CI 95% 1.12-4.87, p=0.024) even after adjustment for age, gender, NT-proBNP, LVEF, aetiology, smoking status, kidney function and NYHA class.
CONCLUSIONS
HSP27 is an independent predictor of prognosis in chronic HF. Our findings suggest that HSP27 may improve risk-stratification in chronic HF beyond known prognostic predictors.
背景
热休克蛋白（HSPs）代表细胞内应激反应机制。慢性心力衰竭（HF）患者 HSP 的（全身）表达的临床意义仍不确定。
方法
采用 ELISA 法检测慢性稳定型 HF 门诊患者血浆 HSP27 水平。对患者进行至少 1 年的随访，并建立多变量 Cox 比例风险模型，用于预测心血管死亡或 HF 相关住院事件。
结果
共纳入 134 例慢性 HF 患者（平均年龄 71±10 岁，34%为女性，平均 LVEF 36±12%）。在平均 527±260 天的随访期间，44 例（33%）患者发生了事件。中位时间至事件为 350±236 天。在 Kaplan-Meier 生存分析中，HSP27 水平高于中位数（3820pg/ml）提示发生事件的风险更高（p=0.03）。即使在校正年龄、性别、NT-proBNP、LVEF、病因、吸烟状况、肾功能和 NYHA 分级后，HSP27 水平升高仍然是事件的独立预测因子（HR，2.33；95%CI 1.12-4.87；p=0.024）。
结论
HSP27 是慢性 HF 预后的独立预测因子。我们的研究结果表明，HSP27 可能改善慢性 HF 患者的风险分层，超过已知的预后预测因子。
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