血清半乳糖凝集素3和成纤维细胞生长因子23与体外循环下心脏瓣膜置换术患者临床预后的相关性  

Correlation between serum galectin-3 and fibroblast growth factor 23 and clinical prognosis of patients undergoing heart valve replacement surgery under cardiopulmonary bypass

作　　者：阮富贵 王海永 彭星星 刘杰 王平善 RUAN Fu-gui;WANG Hai-yong;PENG Xing-xing;LIU Jie;WANG Ping-shan(Department of Cardiac Vascular Surgery,the Affiliated Hospital of Guilin Medical University,Guilin 541001,China)

机构地区：[1]桂林医学附属医院心脏大血管外科,广西桂林市541001

出　　处：《中国心血管病研究》2024年第12期1107-1112,共6页Chinese Journal of Cardiovascular Research

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20180435)。

摘　　要：目的探讨血清半乳糖凝集素3(Gal-3)、成纤维细胞生长因子23(FGF-23)与体外循环(CPB)下心脏瓣膜置换术患者临床预后的相关性。方法选取2021年1月~2023年12月桂林医学附属医院拟行CPB下心脏瓣膜置换术患者521例,于术前测定血清Gal-3、FGF-23水平,所有患者均接受规律随访,根据术后6个月随访情况将患者分为死亡组和存活组。比较两组患者的基线资料、血清Gal-3和FGF-23水平;采用限制性立方样条模型(RCS)分析血清Gal-3、FGF-23与CPB下心脏瓣膜置换术患者临床预后的相关性,采用Cox回归分析临床预后的影响因素,受试者工作特征(ROC)曲线分析血清Gal-3、FGF-23对CPB下心脏瓣膜置换术患者临床预后的预测价值,绘制决策曲线,验证预测模型的临床应用价值。结果随访6个月过程中,剔除19例未完成随访及其他原因死亡的患者,共502例完成随访,其中31例死亡,病死率6.18%。死亡组血浆N末端B型利钠肽原(NT-proBNP)、血清Gal-3、FGF-23水平、纽约心脏病协会(NYHA)心功能分级Ⅲ级患者占比高于存活组(P<0.05);RCS分析显示,CPB下心脏瓣膜置换术患者临床预后与血清Gal-3、FGF-23的关联均呈非线性曲线型剂量反应关系(P<0.05),当术前血清Gal-3、FGF-23分别>26.09μg/L、754.19 ng/L时,CPB下心脏瓣膜置换术患者死亡风险随指标水平升高而增加。Cox回归分析显示,血清Gal-3、FGF-23、血浆NT-proBNP、NYHA心功能分级为CPB下心脏瓣膜置换术患者临床预后的影响因素(P<0.05);ROC曲线显示,血清Gal-3、FGF-23单独及联合预测临床预后的曲线下面积(AUC)均>0.7,且联合预测的AUC更高(P<0.05);决策曲线显示,相较于各指标单独应用,血清Gal-3、FGF-23联合血浆NT-proBNP、NYHA心功能分级Ⅲ级辅助绘制的决策曲线具有更高的净受益率,最大净受益率为0.062。结论血清Gal-3、FGF-23与CPB下心脏瓣膜置换术患者临床预后密切相关,术前血清Gal-3、FGF-23水平越高,�Objective To investigate the correlation between serum galectin-3(Gal-3)and fibroblast growth factor 23(FGF-23)and clinical prognosis of patients undergoing heart valve replacement surgery under cardiopulmonary bypass(CPB).Method A total of 521 patients who underwent heart valve replacement surgery under CPB in the Affiliated Hospital of Guilin Medical University from January 2021 to December 2023 were selected.Serum Gal-3 and FGF-23 levels were measured before surgery,and all patients received regular follow-up.Based on the 6-month follow-up after the surgery,the patients were divided into the mortality group and survival group.Baseline data,serum Gal-3 and FGF-23 levels were compared between the two groups.The correlation between serum Gal-3 and FGF-23 and clinical prognosis of patients undergoing heart valve replacement surgery under CPB was analyzed using a restricted cubic spline model(RCS).The influencing factors of clinical prognosis were analyzed using Cox regression analysis.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive value of serum Gal-3 and FGF-23 on clinical prognosis of patients undergoing heart valve replacement surgery under CPB.Decision curves were plotted to verify the clinical application value of the predictive model.Results During the 6-month follow-up period,after excluding 19 patients who did not complete the follow-up or died from other reasons,a total of 502 patients completed the follow-up,of which 31 died,with a mortality rate of 6.18%.The level of plasma N-terminal pro brain natriuretic peptide(NT-proBNP),serum Gal-3,FGF-23 levels,and New York Heart Association(NYHA)functional classⅢpatients in the mortality group were higher than that in the survival group(P<0.05).RCS analysis indicated that the clinical prognosis of patients undergoing heart valve replacement surgery under CPB showed a non-linear dose-response relationship with serum Gal-3 and FGF-23 levels(P<0.05).When preoperative serum Gal-3 and FGF-23 levels were greater than 26.09μg/L an

关 键 词：体外循环 心脏瓣膜置换术 半乳糖凝集素3 成纤维细胞生长因子23 临床预后 相关性 

分 类 号：R542.5[医药卫生—心血管疾病]