| Objective:Chronic heart failure(CHF)is an end-stage cardiovascular disease which is frequently encountered in clinical practice currently.It can be caused by a variety of factors.As a chronic and spontaneous progressive disease,CHF is not only associated with multiple cardiovascular diseases,and the cardiac functions are also affected by the age,chronic diseases including hypertension,diabetes,dyslipidemia,and obesity of the patients.In recent years,with the in-depth recognition of heart failure,great progress has been made in the clinical diagnosis and treatment of CHF.However,the rates of mortality and rehospitalization remain high in China.Sirtuin4(Sirt4)has been confirmed to be involved in the process of ventricular remodeling,whereas its role in human CHF has not been fully investigated.The objective of present study is to determine the Sirt4 level in serum and common biochemical indexes in CHF patients,and to analyze the correlation between Sirt4 and cardiac functional classification and other clinical indexes,in order to provide a new target for clinical diagnosis,early prevention and treatment of CHF.Methods:A total of 300 CHF patients who met the diagnostic criteria of heart failure and 200 CHF-free patients with hypertension and diabetes visited the Qingdao Municipal Hospital from May to December 2019 were selected.Ninety-five CHF patients met the present experimental criteria and were included in a heart failure group(CHF group).Meanwhile,105 CHF-free patients were selected as a control group,whose basic information including sex,age,height,weight,history of hypertension,history of diabetes,history of coronary atherosclerotic heart disease(CHD),and tobacco history revealed no marked difference from those of the CHF group.Patients in the CHF group were divided into the following groups according to the cardiac functional classification standard established by Newyork Heart Association(NYHA):24 cases with cardiac functional classification Ⅰ;20 cases with cardiac functional classification Ⅱ;22 cases with cardiac functional classification Ⅲ;and 29 cases with cardiac functional classification Ⅳ.Basic information and common clinical data including heart rate,blood pressure,height,weight and body mass index(BMI)of the included patients were collected.Left ventricular ejection fraction(LVEF)was examined using color Doppler ultrasonography.Levels of N-terminal pro B type natriuretic peptide(NT-pro BNP)in the serum of research subjects were measured.Levels of triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),fasting blood glucose(FBG),serum creatinine(Scr),and blood urea nitrogen(BUN)in the serum were detected by biochemical analyzer.Enzyme-linked immunosorbent assay(ELISA)was used to determine the Sirt4 level in the serum of the selected subjects.All experimental data obtained were analyzed by the SPSS statistical software.Measurement data of normal distribution were expressed as mean ±standard deviation.One-way ANOVA was applied for comparative analysis among multiple groups with homogeneous variance.LSD-t tests were employed for pairwise comparison.Data which did not follow a normal distribution were presented by mean values and median values.Mann-Whitney U tests were used for pairwise comparison,and Kruskal Wallis tests were applied for multiple group comparison.Partial correlation analysis was employed to analyze the correlation of multiple variables.Multivariate linear regression was adopted to analyze the influencing factors of LVEF.Multivariate ordered logistic regression analysis was performed on the factors affecting the severity of heart failure.Characteristic curves of Sirt4 and NT-pro BNP were plotted utlimately.The values of P < 0.05 in the previously described results indicated that the difference was statistically significant.Results:1.There were no apparent difference in clinical indicators of age,gender,heart rate,blood pressure,and BMI between the CHF group and control group.There was no substantial difference in general information of hypertension history,diabetes history,CHD history and smoking history.Meanwhile,no significant difference was revealed in biochemical indicators HDL-C,LDL-C,FBG,Cre,and BUN between both groups(all P > 0.05,no statistical significance).The levels of Sirt4,NT-pro BNP in the serum of the CHF group were higher than those in the normal control group(all P < 0.05,the difference was statistically significant).The levels of LVEF,TC and TG were lower than those of the normal control group(P < 0.05,the difference was statistically significant).2.Comparison results among different cardiac functional classification showed that: There were no significant difference in common clinical biochemical indexes of TG,TC,FBG,LDL-C,HDL-C,Cre,and BUN,and general information of blood pressure,heart rate,and BMI among different cardiac functional classification groups(P > 0.05,the difference was not statistically significant).Significant differences were revealed in the serum Sirt4 and NT-pro BNP levels among different cardiac function groups.Both levels increased with the increase of cardiac functional classifications,and there were significant differences among different cardiac functional classifications(all P < 0.05).Meanwhile,the pairwise comparative analysis indicated that: the values of LVEF decreased with the increase of cardiac functional classifications,and there were significant differences among different cardiac function groups(all P < 0.05).3.The results of partial correlation analysis between serum Sirt4 level and various factors in the CHF group demonstrated that: the level of Sirt4 was positively correlated with the level of NT-pro BNP(r = 0.222,P < 0.05,the difference was statistically significant),and it was negatively correlated with LVEF(r =-0.685,P < 0.05,the difference was statistically significant).4.Multivariate linear regression analysis of LVEF showed that: both Sirt4 and NT-pro BNP were independent influencing factors of LVEF(B =-8.364,all P < 0.01).5.The results of multivariate ordered Logistic analysis of cardiac functional classification in each cardiac function classification group were as follows: Sirt4,NT-pro BNP and LVEF were independent risk factors for the severity of heart failure(all P < 0.05),so Sirt4 was one of the indexes to evaluate the deterioration of cardiac function.6.The subject area under the curve of Sirt4 was 0.866(95% confidence interval: 0.817-0.915,P < 0.01).The sensitivity was 74.7%,the specificity was 83.8%,Yoden index was 0.585,and the best cutoff value was 2.21 ng/m L;The combined subject area under the curve of Sirt4 and NT-pro BNP could improve the specificity and sensitivity of CHF detection in different degrees.Conclusions:The present study demonstrated that the level of serum Sirt4 in CHF patients was evidently higher than that in the people without heart failure,and its level was increased with the increase of cardiac functional classifications.The level of Sirt4 was positively correlated with the level of NT-pro BNP whereas negatively correlated with LVEF.Moreover,increased Sirt4 acted as one of the independent risk factors of decreased LVEF.Our research findings suggested that Sirt4 might participate in the deterioration of CHF cardiac function.The level detection provided some references on the diagnosis and severity evaluation of CHF.Combined detection of Sirt4 and NT-pro BNP levels could improve the accuracy of CHF diagnosis.Taken together,we speculated that Sirt4 might be employed as a new target for early diagnosis and prevention of CHF. |
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