慢性心力衰竭患者血清KLK1、KLF2、HDAC4水平及其与心室重构、MACE的关系OA

Objective To investigate the serum levels of tissue kallikrein 1(KLK1),Krüppel-like factor 2(KLF2)and histone deacetylase 4(HDAC4)in patients with chronic heart failure(CHF)and their relation-ship with ventricular remodeling and major adverse cardiovascular events(MACE).Methods A total of 147 CHF patients admitted to Liyuan Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from September 2021 to January 2024 were selected as the CHF group,and 100 healthy people who underwent physical examination in Liyuan Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology during the same period were selected as the control group.Enzyme-linked immunosorbent assay was used to detect the serum levels of KLK1,KLF2 and HDAC4 in all subjects.Pearson correlation analysis was used to analyze the correlation between serum KLK1,KLF2,HDAC4 levels and cardiac function parameters and cardiac structure parameters in CHF patients.Multivariate Logistic regression was used to analyze the influencing factors of MACE in CHF patients.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum KLK1,KLF2 and HDAC4 a-lone and in combination for MACE in CHF patients.Results High density lipoprotein cholesterol(HDL-C)level,left ventricular ejection fraction(LVEF),cardiac output(CO),left ventricular remodeling index(LVRI)and serum KLK1,KLF2,HDAC4 levels in CHF group were significantly lower than those in control group,the levels of triglyceride(TG),fasting plasma glucose(FBG),brain natriuretic peptide(BNP)and left ventricular mass index(LVMI)were significantly higher than those in the control group,the left atrial diame-ter(LAD),left ventricular end-diastolic diameter(LVEDD),ventricular septal thickness(IVST),and left ventricular posterior wall thickness(LVPWT)were all significantly larger than those in the control group,and the differences were statistically significant(P<0.05).The levels of serum KLK1,KLF2 and HDAC4 in patients with New York Heart Association(NYHA)class Ⅳ and Ⅲ were lower than those in CHF patients with NYHA class Ⅱ,and the levels of serum KLK1,KLF2 and HDAC4 in CHF patients with NYHA class Ⅳ were lower than those in patients with NYHA class Ⅲ,and the differences were statistically significant(P<0.05).Pearson correlation analysis showed that serum KLK1,KLF2,and HDAC4 levels in CHF patients were positively correlated with LVEF,CO,and LVRI(P<0.05),and negatively correlated with LAD,LVEDD,IVST,LVPWT,and LVMI(P<0.05).The levels of LVEF,CO and serum KLK1,KLF2 and HDAC4 in the MACE group were significantly lower than those in the non-MACE group,and the level of BNP was signifi-cantly higher than that in the non-MACE group,LVEDD was significantly higher in the MACE group than in the non-MACE group,with statistically significant differences(P<0.05).Multivariate Logistic regression a-nalysis showed that the increase of serum BNP level was a risk factor for MACE in CHF patients(P<0.05),and the increase of serum KLK1,KLF2,and HDAC4 levels were protective factors for MACE in CHF patients(P<0.05).ROC curve analysis showed that the AUC of serum KLK1,KLF2 and HDAC4 alone and in com-bination for predicting MACE in CHF patients were 0.794,0.764,0.785 and 0.910 respectively,the AUC of combined prediction for MACE in CHF patients was greater than that of serum KLK1,KLF2 and HDAC4 a-lone(Z=3.972,3.532,2.960,P<0.05).Conclusion The serum levels of KLK1,KLF2 and HDAC4 in CHF patients are decreased,which are related to the occurrence of ventricular remodeling and MACE.The combina-tion of the three items has a high predictive value for the occurrence of MACE in CHF patients.