血浆Ghrelin和血清FGF21对老年急性心力衰竭患者主要不良心血管事件的评估价值  

Evaluation value of plasma Ghrelin and serum FGF21 for major adverse cardiovascular events in elderly patients with acute heart failure

作　　者：王丹[1] 方正亚 王黎君 WANG Dan;FANG Zhengya;WANG Lijun(Department of Cardiovascular Medicine,Liyang Branch of Jiangsu Provincial People's Hospital(Liyang People's Hospital),Liyang Jiangsu 213300,China)

机构地区：[1]江苏省人民医院溧阳分院(溧阳市人民医院)心血管内科,江苏溧阳213300

出　　处：《中国急救复苏与灾害医学杂志》2023年第11期1469-1473,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省卫生计生委2018年度医学科研指导性课题(编号:Z2018149)。

摘　　要：目的 探讨血浆Ghrelin和血清FGF21对老年急性心力衰竭患者主要不良心血管事件的评估价值。方法选取溧阳市人民医院于2019年3月—2021年9月诊断为急性心力衰竭的老年患者共计200例。患者入院后留取血液样本使用ELISA试剂盒检测血浆Ghrelin水平和血清FGF21水平。对患者进行为期12个月的随访,结局指标为主要不良心脏事件(MACE),依照是否发生MACE对患者进行分组。比较两组患者一般资料、合并症及实验室数据,分析老年急性心力衰竭患者12个月内发生MACE的危险因素。评估血浆Ghrelin和血清FGF21水平对老年急性心力衰竭患者MACE的预测价值。通过ROC曲线确定血浆Ghrelin、血清FGF21的最佳诊断界值,依照最佳诊断界值进行分组,绘制Kaplan-Meier曲线比较组间MACE发生情况。结果 最终观察190例患者,有57例患者出现MACE,MACE发生率为30.0%。依照是否发生MACE将患者分为MACE组和非MACE组,结果显示,MACE组患者年龄明显高于非MACE组患者,差异有统计学意义(P<0.05)。MACE组患者NT-proBNP、Ghrelin、FGF21水平明显高于非MACE组患者,差异有统计学意义(P<0.05)。Cox比例风险模型结果显示,血浆Ghrelin水平、血清FGF21水平的上升与MACE发生率的增加存在明显相关性(P<0.001, HR=196.9, 95%CI:22.72~1706.2;P=0.002, HR=1.015, 95%CI:1.006~1.025)。NT-proBNP水平与MACE发生率并无明显相关性(P=0.872, HR=0.967, 95%CI:0.643~1.454)。血浆Ghrelin水平预测MACE发生的敏感度为82.5%,特异度为80.5%;血清FGF21水平预测MACE发生的敏感度为91.2%,特异度为73.7%。血浆Ghrelin水平和血清FGF21水平联合预测老年急性心力衰竭患者MACE发生的敏感度为84.2%,特异度为85.0%。结论血浆Ghrelin和血清FGF21均为老年急性心力衰竭患者主要不良心血管事件发生的危险因素,二者联合检测对老年急性心力衰竭患者主要不良心血管事件的预测效能高于二者单独检测。Objective To investigate the evaluation value of plasma Ghrelin and serum fibroblast growth factor 21(FGF21)for major adverse cardiovascular events in elderly patients with acute heart failure.Methods A total of 200 elderly patients diagnosed with acute heart failure in Liyang People's Hospital from March 2019 to September 2021 were selected.Serum Ghrelin level and serum FGF21 level were detected by ELISA kit in blood samples collected after admission.The patients were followed up for 12 months with major adverse cardiac events(MACE)outcome,and the patients were grouped according to whether MACE occurred.The general data,comorbidities,and laboratory data of the two groups were compared to analyze the risk factors of MACE in elderly patients with acute heart failure within 12 months.To evaluate the predictive value of plasma Ghrelin and serum FGF21 levels for MACE in elderly patients with acute heart failure.The optimal diagnostic thresholds of plasma Ghrelin and serum FGF21 were determined by ROC curve,and groups were divided according to the optimal diagnostic thresholds.Kaplan-meier curves were drawn to compare the occurrence of MACE between groups.Results MACE was observed in 57 of 190 patients,and the incidence of MACE was 30.0%.According to the occurrence of MACE,patients were divided into MACE group and non-MACE group.The results showed that the age of patients in MACE group was significantly higher than that in non-MACE group,the difference was statistically significant(P<0.05).The levels of N-terminal pro B-type natriuretic peptide(NT-proBNP),Ghrelin and FGF21 in MACE group were significantly higher than those in non-MACE group,the differences were statistically significant(P<0.05).Cox proportional risk model showed that the increase of plasma Ghrelin level and serum FGF21 level was significantly correlated with the increase of MACE incidence(P<0.001,HR=196.9,95%CI:22.72-1706.2;P=0.002,HR=1.015,95%CI:1.006-1.025).There was no significant correlation between NT-probNP level and the incidence of MACE(P=0.87

关 键 词：生长激素释放肽 成纤维细胞生长因子21 急性心力衰竭 预后 

分 类 号：R541.6[医药卫生—心血管疾病]