急性心肌梗死患者血清成纤维细胞生长因子21与心肌纤维化的相关性分析及对长期预后的影响  

Correlation analysis of serum FGF21level and myocardial fibrosis in patient with acute myocardial infarction and its influence on long-term prognosis

作　　者：张静宜 肖华[2] 孙琦[2] 陶晓峰[2] 王晓炎 陈启稚[1] ZHANG Jingyi;XIAO Hua;SUN Qi;TAO Xiaofeng;WANG Xiaoyan;CHEN Qizhi(Department of Cardiology,Shanghai Ninth People′s Hospital,Shanghai Jiaotong University School of Medicine,Shanghai,200011,China;Department of Radiology,Shanghai Ninth People′s Hospital,Shanghai Jiaotong University School of Medicine,Shanghai,200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院心内科,上海200011 [2]上海交通大学医学院附属第九人民医院放射科

出　　处：《临床心血管病杂志》2024年第2期122-127,共6页Journal of Clinical Cardiology

摘　　要：目的:研究急性心肌梗死(acute myocardial infarction,AMI)患者中,血清成纤维细胞生长因子21(FGF21)浓度与心肌纤维化程度的相关性,探讨FGF21水平对患者预后的影响。方法:选取2018年1月—2020年12月就诊于上海交通大学医学院附属第九人民医院确诊为AMI的患者24例(AMI组)与健康志愿者18例(对照组)。所有对象均完成心脏磁共振检查,应用第三方软件CVI42分析磁共振图像,分析得出左心室心功能参数及心肌纤维化程度LGE%,并测定血清FGF21浓度,进行统计学分析。进一步根据血清FGF21浓度将AMI组分为FGF21浓度正常组(13例)和增高组(11例),通过住院电子病历系统收集患者的临床资料,电话或门诊随访患者的长期预后,包括心源性死亡、再发心肌梗死、恶性心律失常等不良心血管事件及出院后1年的心脏超声检查结果,随访时间截至2022年12月31日。结果:①AMI患者的血清FGF21浓度显著高于对照组,差异有统计学意义(P<0.05)。②相关性分析结果显示FGF21浓度与LGE(r=0.763,P<0.01)、LDL(r=0.314,P=0.043)、CK-MB(r=0.444,P<0.01)、CK(r=0.455,P=0.026)呈正相关,与HDL(r=-0.423,P<0.01)呈负相关。在心肌纤维化预测中,FGF21的截断值为0.14ng/mL时,曲线下面积(AUC)为0.718,灵敏度为66.7%,特异度为77.8%。③预后分析结果发现FGF21增高组与正常组复合终点事件发生率无统计学差异,但FGF21增高组出院后LVEF改善显著,差异有统计学意义(P<0.05)。结论:在AMI患者中,FGF21浓度显著升高,且与心肌纤维化程度具有显著正相关性,同时AMI早期FGF21浓度高对患者长期预后有益。Objective:To investigate the correlation between serum FGF21concentration and myocardial fibrosis degree in patients with acute myocardial infarction(AMI),and to explore the effect of FGF21level on the prognosis of patients.Methods:A total of 24patients diagnosed with AMI(AMI group)and 18healthy volunteers(control group)were collected.All subjects completed cardiac magnetic resonance examination(CMR),and the third-party software CVI42was used to analyze the magnetic resonance images,and the left ventricular cardiac function parameters and myocardial fibrosis degree LGE%were analyzed,and the serum FGF21concentration was measured for statistical analysis.According to serum FGF21concentration,AMI group was further divided into FGF21normal group(13cases)and increased group(11cases).Clinical data of patients were collected in the inpatient electronic medical record system,and the long-term prognosis of patients was followed up by telephone or outpatient.Adverse cardiovascular events and cardiac ultrasound results were followed up.Results:①The serum FGF21concentration in AMI patients was significantly higher than that in control group(P<0.05).②Correlation analysis results showed that FGF21concentration was positively correlated with LGE(r=0.763,P<0.01),LDL(r=0.314,P=0.043),CK-MB(r=0.444,P<0.01),CK(r=0.455,P=0.026),and HDL(r=-0.423,P=0.026).P<0.01 had a negative correlation.When the cutoff value of FGF21in the prediction of myocardial fibrosis was 0.14ng/ml,the area under ROC curve(AUC)was 0.718,with a sensitivity of 66.7%and a specificity of 77.8%.③The increased group had a significant improvement in LVEF after discharge(P<0.05).Conclusion:In AMI patients,the concentration of FGF21is significantly increased,and has a significant positive correlation with the degree of myocardial fibrosis,and the high concentration of FGF21in the early stage of MI is beneficial to the long-term prognosis of patients.

关 键 词：心脏磁共振 成纤维细胞生长因子21 急性心肌梗死 心肌纤维化 

分 类 号：R542.2[医药卫生—心血管疾病]