神经丝轻链蛋白与夜间高血压患者左心室肥厚发生风险的相关性研究
Correlation Analysis between Neurofilament Light Chain and the Risk of Left Ventricular Hypertrophy in Patients with Nocturnal Hypertension
刘天缘 1桑婉玥 1彭继平 1程思怡 1黄伊伊 1李欧文 1江洪 1周晓亚1
作者信息
- 1. 430060 湖北省武汉市，武汉大学人民医院心血管内科
- 折叠
摘要
背景 神经丝轻链蛋白（NfL）作为神经损伤及神经炎症的敏感标志物而备受关注，已有研究证明其与高血压及心血管不良事件相关，但目前其与夜间高血压患者左心室肥厚（LVH）的潜在关系尚未明确。目的 探讨NfL与夜间高血压患者LVH发生风险的相关性。方法 选取2022年12月—2024年12月于武汉大学人民医院行24 h动态血压监测（ABPM）且病例资料完整的351例夜间高血压患者为研究对象。将患者按NfL四分位数分为4组：Q1组（NfL≤62.82，88例）、Q2组（62.82<NfL≤92.00，88例）、Q3组（92.00136.40，88例）。收集患者基线资料、24 h ABPM结果、实验室检查结果及心脏彩超结果。根据美国超声心动图学会推荐公式计算左心室质量（LVM）及左心室质量指数（LVMI）。采用Spearman秩相关分析探讨NfL与心脏彩超参数的相关性。应用广义线性回归模型分析不同NfL分组与LVMI的关联。使用Logistic回归分析探讨NfL与夜间高血压患者LVH发生风险之间的关系。绘制受试者工作特征（ROC）曲线评估NfL及自主神经功能相关指标对夜间高血压患者发生LVH风险的预测价值，并进行亚组分析。结果 4组年龄、室间隔舒张期厚度（IVSd）、左心室后壁厚度（LVPWd）、LVM、LVMI比较，差异有统计学意义（P<0.05）。Spearman秩相关性分析结果显示，NfL水平与夜间高血压患者的左心室舒张末期内径（LVIDd）（rs=0.135，P=0.011）、IVSd（rs=0.128，P=0.016）、LVPWd（rs=0.146，P=0.006）、LVM（rs=0.162，P=0.002）及LVMI（rs=0.277，P<0.001）呈正相关。广义线性模型分析结果显示，调整混杂因素后，与Q1水平的NfL相比，Q3（β=0.110，95%CI=0.003~0.217，P=0.044）和Q4（β=0.288，95%CI=0.180~0.395，P<0.001）水平的NfL均是LVMI的影响因素。Logistic回归分析结果显示，调整混杂因素后，NfL水平升高是夜间高血压患者发生LVH的危险因素（OR=1.012，95%CI=1.007~1.016，P<0.001）；与Q1水平的NfL相比，Q3（OR=3.328，95%CI=1.152~9.611，P=0.026）和Q4（OR=9.059，95%CI=3.278~25.036，P<0.001）水平的NfL均是夜间高血压患者发生LVH的危险因素。ROC曲线分析结果显示，NfL、去甲肾上腺素（NE）、乙酰胆碱（ACh）、NE/ACh预测夜间高血压患者发生LVH风险的ROC曲线下面积（AUC）分别为0.744、0.618、0.577、0.603，灵敏度分别为75.0%、50.0%、48.5%、48.5%，特异度分别为63.3%、69.3%、51.5%、75.3%。亚组分析结果显示，NfL水平与夜间高血压患者LVH发生风险在年龄、男性、BMI、估算肾小球滤过率（eGFR）亚组中呈正相关（P<0.05）。结论 在夜间高血压患者中，NfL水平与LVH发生风险独立相关，且对识别该类患者中的LVH高危患者具有一定的临床预测价值。
Abstract
BackgroundNeurofilament light chain (NfL), a sensitive biomarker of neuroal injury and neuroinflammation, has attracted increasing attention. Previous studies have demonstrated its associations with hypertension and adverse cardiovascular events;however, the potential relationship between NfL and left ventricular hypertrophy (LVH) in patients with nocturnal hypertension remains remains unclear. ObjectiveTo examine the association between serum NfL levels and the risk of LVH in patients with nocturnal hypertension. MethodsA total of 351 patients with nocturnal hypertension who underwent 24-hour ambulatory blood pressure monitoring (ABPM) with complete clinical data at Renmin Hospital of Wuhan University from December 2022 to December 2024 were enrolled. Patients were divided into four groups according to NfL quartiles:Q1 (NfL62.82, n=88), Q2 (62.82<NfL 92.00, n=88), Q3 (92.00136.40, n=88). Baseline characteristics, 24-hour ABPM data, laboratory results, and transthoracic echocardiographic parameters were collected. Left ventricular mass (LVM) and left ventricular mass index (LVMI) were calculated using the formula recommended by the American Society of Echocardiography. Spearman's rank correlation analysis was used to assess associations between NfL and echocardiographic parameters. Generalized linear models were applied to analyze the associations between NfL quartiles and LVMI. Logistic regression analysis was used to evaluate the relationship between NfL levels and the risk of LVH. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive value of NfL and autonomic function-related indicators for the risk of LVH in patients with nocturnal hypertension, and subgroup analyses were conducted. ResultsSignificant differences were observed among the four groups in age, interventricular septal thickness in diastole (IVSd), left ventricular posterior wall thickness at end-diastole (LVPWd), LVM, and LVMI (P<0.05). Spearman correlation analysis showed that NfL levels were positively correlated with left ventricular internal diameter at end-diastole (LVIDd)(rs=0.135, P=0.011), IVSd (rs=0.128, P=0.016), LVPWd (rs=0.146, P=0.006), LVM (rs=0.162, P=0.002), and LVMI (rs=0.277, P<0.001). After adjustment for confounding factors, the generalized linear model showed that, compared with Q1, NfL levels in Q3 (=0.110, 95%CI=0.003-0.217, P=0.044) and Q4 (=0.288, 95%CI=0.180-0.395, P<0.001) were significantly associated with LVMI. Logistic regression analysis showed that elevated NfL levels were an independent risk factor for LVH in patients with nocturnal hypertension (OR=1.012, 95%CI=1.007-1.016, P<0.001). Compared with Q1, NfL levels in Q3 (OR=3.328, 95%CI=1.152-9.611, P=0.026) and Q4 (OR=9.059, 95%CI=3.278-25.036, P<0.001) were associated with a significantly increased risk of LVH. ROC curve analysis showed that the areas under the ROC curve (AUC) of NfL, norepinephrine (NE), acetylcholine (ACh), and the NE/ACh ratio for predicting LVH risk were 0.744, 0.618, 0.577, and 0.603, respectively, with sensitivities of 75.0%, 50.0%, 48.5%, and 48.5% and specificities of 63.3%, 69.3%, 51.5%, and 75.3%. Subgroup analyses indicated that NfL levels were positively associated with LVH risk in subgroups defined by age, male sex, BMI, and estimated glomerular filtration rate (eGFR)(P<0.05). ConclusionIn patients with nocturnal hypertension, serum NfL levels are independently associated with the risk of LVH and may have clinical value in identifying individuals at high risk of LVH.关键词
高血压/肥大，左心室/夜间高血压/左心室肥厚/神经丝轻链蛋白/相关性研究/Logistic 模型引用本文复制引用
刘天缘,桑婉玥,彭继平,程思怡,黄伊伊,李欧文,江洪,周晓亚.神经丝轻链蛋白与夜间高血压患者左心室肥厚发生风险的相关性研究[EB/OL].(2026-01-09)[2026-01-12].https://chinaxiv.org/abs/202601.00110.学科分类
医学研究方法/基础医学/临床医学
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