IGFBP7和CaN异常表达预测射血保留型心力衰竭合并心房颤动患者左心房纤维化程度和形变功能的研究
Abnormal expression of IGFBP7 and CaN predicts left atrial fibrosis and deformable function in heart failure patients with preserved ejection fraction and atrial fibrillations
达迎晓 1狄宁宁 1周松 1崔振川 1黄玲芳1
作者信息
- 1. 054000 河北省邢台市,邢台市中心医院心内二科
- 折叠
摘要
目的 探究胰岛素样生长因子结合蛋白7(IGFBP7)和钙调神经磷酸酶(CaN)异常表达对射血保留型心力衰竭(HFpEF)合并心房颤动(AF)患者左心房纤维化程度和形变功能的预测价值.方法 选取邢台市中心医院收治的HFpEF患者180例,根据是否合并AF分为单纯HFpEF组(n=94)及合并组(n=86),同时选取同期健康体检人群为对照组(n=80).比较三组受试者左心房纤维化程度和形变功能、IGFBP7及CaN水平,并采用多元logistic回归分析影响HFpEF合并AF的危险因素,Spearman相关性分析血清IGFBP7和CaN水平与左心房纤维化程度和形变功能的相关性,受试者工作特征曲线(ROC曲线)分析IGFBP7和CaN水平对HFpEF合并AF的预测价值.结果 HFpEF患者左心房收缩期整体峰值纵向应变值(LAS-a)、左心室收缩期左心房整体峰值纵向应变值(LAS-s)、左心房整体总排空分数(LATEF)显著低于对照组[(35.02±4.03)比(38.86±3.89),(15.03±2.31)比(18.74±2.96),(41.87±9.46)比(51.98±9.87),P<0.05],且合并组显著低于单纯HFpEF组[(30.89±2.94)比(35.02±4.03),(11.89±3.16)比(15.03±2.31),(34.24±8.21)比(41.87±9.46),P<0.05];左心房内径(LAD)、二尖瓣口舒张早期峰值血流速度/左心室舒张早期室间隔侧二尖瓣环根部运动峰值速度(E/e′)、左心房容积指数(LAVI)、心肌做功指数(Tei指数)显著高于对照组[(40.68±5.89)比(33.72±4.52),(10.09±1.87)比(7.62±1.45),(24.86±4.78)比(21.32±4.04),(24.86±4.78)比(21.32±4.04),(0.42±0.08)比(0.38±0.08),P<0.05],且合并组显著高于单纯HFpEF组[(44.72±6.02)比(40.68±5.89),(11.32±2.46)比(10.09±1.87),(28.67±5.01)比(24.86±4.78),(0.45±0.06)比(0.42±0.08),P<0.05].HFpEF患者IGFBP7、CaN水平显著高于对照组(P<0.05),且合并组显著高于单纯HFpEF组(P<0.05).多因素logistic回归分析结果显示,IGFBP7、CaN、LAS-a、LAS-s、LAD、E/e′、LAVI、Tei指数、年龄是影响HFpEF合并AF的危险因素(P<0.05).Spearman相关性分析表明,IGFBP7、CaN水平与LAS-a、LAS-s、LATEF呈明显的负相关(r=-0.512、-0.486,-0.508、-0.423,-0.326、-0.428,P<0.05),与LAD、E/e′、LAVI、Tei指数、年龄呈明显的正相关(r=0.328、0.289,0.218、0.321,0.238、0.264,0.208、0.142,0.482、0.358,P<0.05).ROC曲线分析显示,IGFBP7和CaN水平预测HFpEF合并AF的曲线下面积分别为0.903、0.999(P<0.001),最佳截点分别为24.04、0.42 ng/ml,敏感度分别为82.6%、98.8%,特异度分别为87.2%、99.7%.结论 IGFBP7和CaN的异常表达可能与HFpEF合并AF患者左心房纤维化程度和左心房形变功能有关,其可作为HFpEF合并AF的预测指标.
Abstract
Objective To investigate the predictive value of abnormal expression of IGFBP7 and CaN for left atrial fibrosis and deformable function in patients with heart failure with preserved ejection(HFpEF)and atrial fibrillation(AF).Methods 180 patients with HFpEF admitted to our hospital were selected and divided into the simple HFpEF group(n=94)and the combined group(n=86)according to whether they were complicated with AF.At the same time,80 healthy people were selected as the control group.The degree of left atrial fibrosis and left atrial deformable function,insulin-like growth factor binding protein 7(IGFBP7)and calcineurin(CaN)levels were compared among the three groups.Multivariate logistic regression analysis was used to analyze the risk factors for HFpEF complicated with AF.Spearman correlation analysis was used to analyze the correlation between serum IGFBP7 and CaN levels and left atrial fibrosis and left atrial deformable function.Receiver operating characteristic curve(ROC curve)was used to analyze the predictive value of IGFBP7 and CaN levels for HFpEF with AF.Results The LAS-a,LAS-s and LATEF of HFpEF patients were significantly lower than the control group[(35.02±4.03)vs.(38.86±3.89),(15.03±2.31)vs.(18.74±2.96),(41.87±9.46)vs.(51.98±9.87),P<0.05],and all above in the combined group were significantly lower than the HFpEF group[(44.72±6.02)vs.(40.68±5.89),(11.32±2.46)vs.(10.09±1.87),(28.67±5.01)vs.(24.86±4.78),(0.45±0.06)vs.(0.42±0.08),P<0.05].LAD,E/e′,LAVI,and Tei index of HFpEF patients were significantly higher than the control group[(40.68±5.89)vs.(33.72±4.52),(10.09±1.87)vs.(7.62±1.45),(24.86±4.78)vs.(21.32±4.04),(24.86±4.78)vs.(21.32±4.04),(0.42±0.08)vs.(0.38±0.08),P<0.05],and all above in the combined group were significantly higher than the HFpEF group(44.72±6.02)vs.(40.68±5.89),(11.32±2.46)vs.(10.09±1.87),(28.67±5.01)vs.(24.86±4.78),(0.45±0.06)vs.(0.42±0.08),P<0.05].The levels of IGFBP7 and CaN in HFpEF patients were significantly higher than the control group(P<0.05),and both above in the combined group was significantly higher than the HFpEF group(P<0.05).The results of multivariate logistic regression analysis showed that IGFBP7,CaN,LAS-a,LAS-s,LAD,E/e′,LAVI,Tei index and age were the risk factors for HFpEF with AF(P<0.05).Spearman correlation analysis showed that IGFBP7 and CaN levels were negatively correlated with LAS-a,LAS-s and LATEF(r=-0.512,-0.486;-0.508,-0.423;-0.326,-0.428;P<0.05),but positively correlated with LAD,E/e′,LAVI,Tei index and age(r=0.328,0.289;0.218,0.321;0.238,0.264;0.208,0.142;0.482,0.358;P<0.05).ROC curve analysis showed that the area under the curve of IGFBP7 and CaN for predicting HFpEF with AF was 0.903 and 0.999(P<0.001),the optimal cut-off point was 24.04 ng/mL and 0.42 ng/mL,the sensitivity was 82.6%and 98.8%,and the specificity was 87.2%and 99.7%,respectively.Conclusion The abnormal expression of IGFBP7 and CaN may be related to left atrial fibrosis and deformable function in HFpEF patients with AF,and they can be used as the predictors of HFpEF with AF.
关键词
射血保留型心力衰竭/心房颤动/胰岛素样生长因子结合蛋白7/钙调神经磷酸酶/左心房Key words
Heart failure with preserved ejection/Atrial fibrillation/Insulin-like growth factor binding protein 7/Calcineurin/Left atrial引用本文复制引用
出版年
2024
NETL
NSTL
万方数据