目的 探讨慢性心力衰竭（CHF）患者血清脂肪细胞型脂肪酸结合蛋白（AFABP）、聚腺苷二磷酸核糖聚合酶1（PARP1）、葡萄糖调节蛋白78（GRP78）、胰岛素样生长因子结合蛋白-7（IGFBP-7）水平与其临床分型、预后的关系。 方法 选取2023年1月至2025年1月医院收治的259例CHF患者（CHF组）及同期259例年龄、性别匹配的健康体检者（对照组）。依据美国纽约心脏疾病学会（NYHA）心功能分级将CHF患者分为Ⅱ级（106例）、Ⅲ级（91例）、Ⅳ级（62例），根据左心室射血分数（LVEF）将CHF患者分为3种临床亚型，包括射血分数保留型（HFpEF，LVEF ≥ 50%）、轻度降低型（HFmrEF，LVEF 41% ~ 49%）及降低型（HFrEF，LVEF ≤ 40%），各为114例、91例、54例，分别列为保留组、临界组、减低组。治疗后随访6个月，随访期间失访11例，共248例完成随访。根据是否发生主要不良心脏事件（MACE，包括心源性死亡或心衰再入院）分为预后不良组（64例）、预后良好组（184例）。统计所有研究对象临床资料，比较CHF组、对照组、预后不良组、预后良好组、不同心功能分级、临床分型CHF患者血清AFABP、PARP1、GRP78、IGFBP-7水平。采用Spearman相关性分析血清AFABP、PARP1、GRP78、IGFBP-7水平与NYHA心功能分级及临床分型的相关性。采用多因素logistic回归分析CHF患者不良预后的危险因素。通过受试者工作特征（ROC）曲线分析血清AFABP、PARP1、GRP78、IGFBP-7水平联合检测对CHF患者不良预后的预测效能。 结果 CHF组血清AFABP、PARP1、GRP78、IGFBP-7水平均明显高于对照组（P < 0.05）。随着NYHA心功能分级恶化（从Ⅱ级到Ⅳ级）及LVEF降低（从HFpEF到HFrEF），各指标水平均呈逐步升高趋势（P < 0.05）。Spearman分析发现，血清AFABP、PARP1、GRP78、IGFBP-7水平与NYHA心功能分级呈正相关（r = 0.652、0.570、0.631、0.588，P < 0.05），与患者临床分型呈正相关（r = 0.496、0.768、0.601、0.608，P < 0.05）。预后不良组、预后良好组血清AFABP、PARP1、GRP78、IGFBP-7水平及心功能分级、临床分型占比等比较差异有统计学意义（P < 0.05）。多因素logistic回归分析结果显示，心功能分级更差（OR = 3.086，95%CI：1.376 ~ 6.921）、HFrEF表型（OR = 3.647，95%CI：1.921 ~ 6.923）、AFABP水平高（OR = 2.675，95%CI：1.248 ~ 5.734）、PARP1水平高（OR = 2.713，95%CI：1.298 ~ 5.669）、GRP78水平高（OR = 2.492，95%CI：1.113 ~ 5.576）、IGFBP-7水平高（OR = 2.237，95%CI：1.158 ~ 4.321）均为CHF患者预后不良的危险因素（均P < 0.05）。绘制ROC曲线发现，血清AFABP、PARP1、GRP78、IGFBP-7水平联合检测对CHF患者不良预后的AUC值（0.936，95%CI：0.898 ~ 0.963）高于各指标单一检测（P < 0.05），且联合检测的敏感度和特异度为90.62%、80.43%。 结论 AFABP、PARP1、GRP78、IGFBP-7水平在CHF患者血清中高表达，其水平与CHF患者心功能分级和临床分型紧密相关；心功能分级更差、HFrEF表型、AFABP水平高、PARP1水平高、GRP78水平高、IGFBP-7水平高均为CHF患者预后不良的危险因素。AFABP、PARP1、GRP78、IGFBP-7四者联合检测对CHF患者不良预后预测价值高，有望成为评估CHF病情及预后的新型生物标志物组合。

Objective To explore the relationship between the levels of serum adipocyte fatty acid binding protein （AFABP）， polyadenosine diphosphate ribose polymerase 1 （PARP1）， glucose-regulated protein 78 （GRP78）， and insulin-like growth factor binding protein-7 （IGFBP-7） in patients with chronic heart failure （CHF）， and the relationship between these levels and their clinical classification and prognosis. Methods A total of 259 patients with CHF who were admitted to our hospital from January 2023 to January 2025 （CHF group） and 259 healthy individuals with age- and gender-matching who underwent physical examinations during the same period （control group） were selected. According to the cardiac function classification of the New York Heart Association （NYHA）， CHF patients were divided into grade II （106 cases）， grade III （91 cases）， and grade IV （62 cases）. CHF patients were classified into three clinical subtypes based on left ventricular ejection fraction （LVEF）， namely the heart failure with preserved ejection fraction （HFpEF， LVEF ≥ 50%）， the heart failure with mildly reduced ejection fraction （HFmrEF， LVEF 41% - 49%）， and the heart failure with reduced ejection fraction （HFrEF， LVEF ≤ 40%）， with 114 cases， 91 cases， and 54 cases respectively. These subtypes are respectively referred to as the preservation group， the mild-reduction group， and the reduction group. After the treatment， a 6-month follow-up was carried out. During the follow-up period， 11 cases were lost to follow-up， while a total of 248 cases successfully completed the follow-up. Based on the occurrence of major adverse cardiac events （MACE， including cardiac death or rehospitalization due to heart failure）， the cases were divided into the poor prognosis group （64 cases） and the good prognosis group （184 cases）. The clinical data of all the research subjects were statistically analyzed， and the levels of serum AFABP， PARP1， GRP78， and IGFBP-7 in CHF patients with different cardiac function grades and clinical types were compared among the CHF group， the control group， the poor prognosis group， and the good prognosis group. Spearman correlation analysis was employed to examine the correlations between the levels of serum AFABP， PARP1， GRP78， and IGFBP-7 and the NYHA cardiac function classification and clinical typing. Multivariate logistic regression analysis was utilized to identify the risk factors for poor prognosis in patients with CHF. The predictive efficacy of the combined detection of serum AFABP， PARP1， GRP78， and IGFBP-7 levels for the poor prognosis of CHF patients was evaluated by the receiver operating characteristic curve （ROC）. Results The levels of serum AFABP， PARP1， GRP78， and IGFBP-7 in the CHF group were significantly higher than those in the control group （P < 0.05）. As the NYHA cardiac function classification deteriorated （from grade II to grade IV） and the LVEF decreased （from HFpEF to HFrEF）， the levels of each index exhibited a gradually increasing trend （P < 0.05）. Spearman analysis indicated that the levels of serum AFABP， PARP1， GRP78， and IGFBP-7 were positively correlated with the NYHA cardiac function classification （r = 0.652， 0.570， 0.631， 0.588， P < 0.05） and also positively correlated with the patient's clinical classification （r = 0.496， 0.768， 0.601， 0.608， P < 0.05）. There were statistically significant differences in the levels of serum AFABP， PARP1， GRP78， and IGFBP-7， as well as the proportion of cardiac function classification and clinical classification， between the poor-prognosis group and the good-prognosis group （P < 0.05）. The results of multivariate logistic regression analysis showed that a worse cardiac function classification （OR = 3.086， 95%CI： 1.376 - 6.921）， the HFrEF phenotype （OR = 3.647， 95%CI： 1.921 - 6.923）， a high AFABP level （OR = 2.675， 95% CI 1.248 - 5.734）， a high PARP1 level （OR = 2.713， 95%CI： 1.298 - 5.669）， a high GRP78 level （OR = 2.492， 95%CI： 1.113 - 5.576）， and a high IGFBP-7 level （OR = 2.237， 95%CI： 1.158 - 4.321） were all risk factors for poor prognosis in CHF patients （all P < 0.05）. After drawing the ROC curve， it was found that the combined detection of serum AFABP， PARP1， GRP78， and IGFBP-7 levels had an AUC value for the poor prognosis of CHF patients （0.936， 95%CI： 0.898 - 0.963）， which was higher than that of individual detection of each index （P < 0.05）. The sensitivity and specificity of the combined detection were 90.62% and 80.43%， respectively. Conclusions The levels of AFABP， PARP1， GRP78， and IGFBP-7 are highly expressed in the serum of patients with CHF. These levels are closely related to the cardiac function classification and clinical type of CHF patients. A worse cardiac function classification， the HFrEF phenotype， high levels of AFABP， PARP1， GRP78， and IGFBP-7 are all risk factors for the poor prognosis of CHF patients. The combined detection of AFABP， PARP1， GRP78， and IGFBP-7 has high predictive value for the poor prognosis of CHF patients and is expected to become a new biomarker combination for evaluating the condition and prognosis of CHF.