血清成纤维细胞生长因子21和脂肪酸结合蛋白4检测对急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后心力衰竭的预测价值  

Predictive value of detection of serum fibroblast growth factor 21 and fatty acid binding protein 4 for heart failure after percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction

作　　者：包美珍[1] 韩惠[2] BAO Mei-zhen;HAN Hui(Cardiovascular Department,Inner Mongolia Medical University Affiliated Hospital,Hohhot 010000,China;Respiratory Department,Inner Mongolia Medical University Affiliated Hospital,Hohhot 010000,China)

机构地区：[1]内蒙古医科大学附属医院心血管内科,内蒙古自治区呼和浩特市010000 [2]内蒙古医科大学附属医院呼吸科,内蒙古自治区呼和浩特市010000

出　　处：《中国心血管病研究》2024年第5期469-474,共6页Chinese Journal of Cardiovascular Research

摘　　要：目的探究血清成纤维细胞生长因子21(FGF21)和脂肪酸结合蛋白4(FABP4)检测对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后心力衰竭的预测价值。方法选取2020年9月至2022年9月内蒙古医科大学附属医院接诊的113例STEMI患者为研究对象,依据PCI术后1年是否发生心力衰竭(心衰),将其分为心衰组(n=32)和非心衰组(n=81)。应用ELISA法测定血清FGF21、FABP4表达水平,比较两组血清FGF21、FABP4水平,多因素logistic回归分析影响STEMI患者PCI术后发生心力衰竭的相关因素,ROC曲线评估血清FGF21、FABP4水平对STEMI患者PCI术后心力衰竭发生的预测价值。结果心衰组心率次数、C反应蛋白(CRP)、心肌肌钙蛋白(cTnI)、N末端B型利钠肽原(BNP)、利尿剂使用比例均显著高于非心衰组,左心室射血分数(LVEF)显著低于非心衰组(P<0.05)。心衰组血清FGF21、FABP4表达水平均明显高于非心衰组[(228.37±33.07)ng/L比(185.68±25.52)ng/L、(34.26±5.51)ng/ml比(26.87±4.67)ng/ml,t=7.345、7.195,P<0.05]。血清FGF21(95%CI 1.371~8.191)、FABP4(95%CI 1.176~4.090)及发病到至导丝通过时间(95%CI 1.058~8.157)是影响STEMI患者PCI术后发生心力衰竭的危险因素(OR>1,P<0.05),LVEF(95%CI 0.473~0.913)是保护因素(OR<1,P<0.05)。血清FGF21、FABP4单独及二者联合预测STEMI患者PCI术后发生心力衰竭的曲线下面积(AUC)分别为0.828、0.856、0.934,二者联合优于单一(Z二者联合-FGF21=1.971、Z二者联合-FABP4=2.417,P=0.048、P=0.015)。结论STEMI患者PCI术后发生心力衰竭血清FGF21、FABP4水平均明显升高,二者联合对STEMI患者PCI术后发生心力衰竭的风险具有更高的预测价值。Objective To explore the predictive value of detection of serum fibroblast growth factor 21(FGF21)and fatty acid binding protein 4(FABP4)for heart failure after percutaneous coronary intervention(PCI)in patients with acute ST segment elevation myocardial infarction(STEMI).Methods From September 2020 to September 2022,113 STEMI patients admitted into our hospital were collected as subjects.The patients were separated into the heart failure group(n=32)and the non heart failure group(n=81)according to whether heart failure occurred one year after PCI.ELISA method was applied to measure the expression levels of serum FGF21 and FABP4;the serum levels of FGF21 and FABP4 were compared between the two groups.Multivariate logistic regression was applied to analyze the related factors affected the heart failure in STEMI patients after PCI.ROC curve was applied to evaluate the predictive value of serum FGF21 and FABP4 levels for the heart failure in STEMI patients after PCI.Results The heart rate,C-reactive protein(CRP),cardiac troponin(cTnI),B-type natriuretic peptide precursor(BNP)and the proportion of using diuretics in the heart failure group were obviously higher than those in the non heart failure group,and the left ventricular ejection fraction(LVEF)was obviously lower than that in the non heart failure group(P<0.05).Serum FGF21 and FABP4 expression levels in the heart failure group were significantly higher than those in the non-heart failure group[(228.37±33.07)ng/L vs.(185.68±25.52)ng/L,(34.26±5.51)ng/ml vs.(26.87±4.67)ng/ml,t=7.345,7.195,P<0.05].Serum FGF21(95%CI 1.371-8.191),FABP4(95%CI 1.371-8.191)and time from onset to passage of the guide wire(95%CI 1.058-8.157)were the risk factors for heart failure in STEMI patients after PCI(OR>1,P<0.05),while LVEF(95%CI 0.473-0.913)was the protective factor(OR<1,P<0.05).The area under the curve(AUC)of serum FGF21,FABP4 and their combination in predicting heart failure after PCI in STEMI patients was 0.828,0.856,and 0.934,respectively;the joint prediction of the two is

关 键 词：心力衰竭 成纤维细胞生长因子21 脂肪酸结合蛋白4 急性ST段抬高型心肌梗死 

分 类 号：R541.6[医药卫生—心血管疾病]