Predictive Value Of Chitinase-3-like Protein-1 In Heart Failure

Background and Objective:Chitinase 3-like protein 1 is an inflammatory marker secreted by macrophages.In recent years,it has been found that the serum concentration of CHI3L1 is increasing in some cardiovascular diseases such as coronary heart disease,hypertension and atrial fibrillation.However,the relationship between CHI3L1 and heart failure is still unclear.The aim of this study was to observe the changes of serum CHI3L1 level in patients with heart failure,to explore its relationship with the severity of heart failure,N-terminal B-type natriuretic peptide(NT-proBNP)and ventricular remodeling,and to evaluate its clinical value in the diagnosis and treatment of heart failure.Methods:A total of 103 patients with heart function stages A,B,C,and D who were admitted to the Affiliated Hospital of Yangzhou University from October 2018 to December 2018 were selected as the research subjects.The patients with stage C and D cardiac function were divided into NYHA?,?,and ? levels according to the New York Heart Association cardiac function grading.The enrollment criteria refer to the Chinese guidelines for diagnosis and treatment of heart failure in 2018.At the same time,24 healthy persons in the physical examination center of our hospital were selected as the control group.The whole blood of the subjects was collected and the serum was separated and frozen in the refrigerator at-80 C.The general data of the selected persons(including name,sex,age,BMI,blood pressure,blood lipid,liver function,renal function and blood routine)were recorded.The patients in the heart failure group completed the Heart echocardiography during hospitalization and recorded the left ventricular ejection fraction(LVEF)and left ventricular end diastolic diameter(LVEDD)and other cardiac function indicators.The serum concentration of CHI3L1 was detected by ELISA and NT-proBNP was determined by electrochemiluminescence immunoassay.SPSS.24 software was used to analyze the difference and correlation of CHI3L1,NT-proBNP,LVEF,LVEDD and other indicators among subgroups.Receiver operating characteristic curve(ROC)was used to evaluate the predictive value of CHI3L1 on the Occurrence of Heart FailureResults:1.The level of CHI3L1 in NYHA ?-? group was higher than that in control group,and the difference was statistically significant(P<0.05).The level of CHI3L1 in NYHA ? group and ? group was higher than that in NYHA ? group,and the level of CHI3L1 in NYHA ? group was higher than that in NYHA ? group(P<0.05)2.The levels of CHI3L1 in patients with stage B,C and D of cardiac function were higher than those in stage A,the difference was statistically significant(P<0.05).There was no significant difference in CHI3L1 level between stage C and stage B(P>0.05).The levels of CHI3L1 in stage D were higher than those in stage B and stage C,the difference was statistically significant(P<0.05)3.CHI3L1 is positively correlated with NT-proBNP and LVEDD,negatively correlated with LVEF,and most strongly correlated with NT-proBNP.NT-proBNP is negatively correlated with LVEF,had no correlation with LVEDD4.The area under the ROC curve(AUC)of CHI3L1 to determine the ability of heart failure was 0.920(95%confidence interval:0.864-0.975),and the AUC of NT-proBNP to determine the ability of heart failure was 0.925(95%confidence interval:0.874-0.977),the AUC of LVEDD to judge the ability of heart failure was 0.782(95%confidence interval 0.671-0.842),AUCNT-proBNP>AUCCHI3L1>AUCLVEDD.Conclusion:1.The serum CHI3L1 level in patients with heart failure increases with the increase of NYHA cardiac function grade,and is positively correlated with NT-proBNP,so it can be used as a new biomarker to evaluate the severity of heart failure,but its reliability is lower than NT-proBNP.2.The level of CHI3L1 in patients with heart failure during ventricular remodeling(stage B,C and D)was higher than that in patients with stage A,but there was no significant difference between stage B and C.The level of CHI3L1 in patients with heart failure was positively correlated with LVEDD,negatively correlated with LVEF,The positive correlation between NT-proBNP level and LVEDD was less than that of CHI3L1,and had no correlation with LVEF.CHI3L1 is superior to NT-proBNP in reflecting ventricular remodeling,and has a certain early warning value for early heart failure diagnosis.