心力衰竭患者的循环CD19 B细胞计数、心肌损伤及临床结局
Circulating CD19 B cell count, myocardial injury and clinical outcomes in patients with heart failure.
作者信息
Kobayashi Yuta, Otaki Yoichiro, Watanabe Tetsu, Yamaguchi Ryuhei, Ono Hiroe, Tachibana Shingo, Sato Junya, Hashimoto Naoaki, Wanezaki Masahiro, Kutsuzawa Daisuke, Arimoto Takanori, Watanabe Masafumi
机构信息
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
出版信息
ESC Heart Fail. 2025 Oct;12(5):3512-3523. doi: 10.1002/ehf2.15382. Epub 2025 Jul 22.
AIMS
Heart failure (HF) is a steadily increasing health problem associated with a high mortality rate. Lymphocytopenia is common and reportedly associated with poor clinical outcomes in patients with HF. Alterations in circulating lymphocyte subsets have not been examined. The current study focused on the CD19 cell count, B cells and examined whether alteration of lymphocyte subsets can predict clinical outcomes in patients with HF.
METHODS
Three hundred ninety-five consecutive patients with HF were enrolled (mean age 73, 59.6% men). Circulating lymphocyte subset counts (CD3 cells: T cells; CD19 cells: B cells; and CD56 cells: NK cells) were evaluated. All patients were prospectively followed for a median period of 374 days. The primary and secondary endpoints were all-cause mortality and HF-related events, respectively.
RESULTS
Simple linear analysis indicated that circulating CD19 B cell counts negatively correlated with heart-type fatty acid-binding protein levels (r = -0.3669; P < 0.0001). The C-index of the CD19 B cell count for all-cause mortality was the highest among the lymphocyte subset counts (C-index 0.73085 vs. 0.69063, 0.65312, 0.60117). Multivariate Cox proportional hazard regression analysis demonstrated that the CD19 B cell count was an independent predictor of all-cause mortality and HF-related events after adjusting for confounding risk factors [hazard ratio (HR) 0.57; confidence interval (CI) 0.45-0.71; P < 0.0001 for all-cause mortality; HR 0.79; CI 0.64-0.98; P = 0.0293 for HF-related events], but not for other subset counts. Adding the CD19 B cell count to the basic risk factors significantly improved the C-index for all-cause mortality, with a significant net reclassification index and integrated discrimination improvement (C-index 0.8000 vs. 0.7609; P = 0.0256).
CONCLUSIONS
Circulating CD19 B cell counts correlated with myocardial injury and could be a feasible marker for clinical outcomes in patients with HF.
目的
心力衰竭（HF）是一个日益严重的健康问题，死亡率很高。淋巴细胞减少很常见，据报道与HF患者不良临床结局相关。循环淋巴细胞亚群的改变尚未得到研究。本研究聚焦于CD19细胞计数、B细胞，并探讨淋巴细胞亚群的改变是否能预测HF患者的临床结局。
方法
纳入395例连续性HF患者（平均年龄73岁，男性占59.6%）。评估循环淋巴细胞亚群计数（CD3细胞：T细胞；CD19细胞：B细胞；CD56细胞：NK细胞）。所有患者前瞻性随访中位时间为374天。主要终点和次要终点分别为全因死亡率和HF相关事件。
结果
简单线性分析表明，循环CD19 B细胞计数与心脏型脂肪酸结合蛋白水平呈负相关（r = -0.3669；P < 0.0001）。在淋巴细胞亚群计数中，CD19 B细胞计数对全因死亡率的C指数最高（C指数为0.73085，而其他分别为0.69063、0.65312、0.60117）。多变量Cox比例风险回归分析表明，在校正混杂风险因素后，CD19 B细胞计数是全因死亡率和HF相关事件的独立预测因子[风险比（HR）0.57；置信区间（CI）0.45 - 0.71；全因死亡率P < 0.0001；HF相关事件HR 0.79；CI 0.64 - 0.98；P = 0.0293]，但对其他亚群计数无此作用。将CD19 B细胞计数加入基本风险因素后，显著提高了全因死亡率的C指数，并有显著的净重新分类指数和综合判别改善（C指数0.8000对0.7609；P = 0.0256）。
结论
循环CD19 B细胞计数与心肌损伤相关，可能是HF患者临床结局的一个可行标志物。
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