血清脂联素、成纤维生长因子-23在心脏瓣膜置换术患者预后中的评估价值

张超; 韩冬; 范迪堃; 高建朝; 杨侃

doi:10.7619/jcmp.20233242

血清脂联素、成纤维生长因子-23在心脏瓣膜置换术患者预后中的评估价值

Prognostic value of serum adiponectin and fibroblast growth factor-23 in patients undergoing heart valve replacement

摘要

摘要:
目的探讨血清脂联素、成纤维生长因子-23(FGF23)水平在心脏瓣膜置换术患者预后中的评估价值。
方法选取行心脏瓣膜置换术的患者98例为研究组。根据研究组患者的预后情况分为预后良好组(n=67)和预后不良组(n=31)。选取同期健康体检者90例为对照组。采用Spearman法分析血清脂联素、FGF23水平分别与血浆N末端B型利钠肽前体(NT-proBNP)水平和急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分的相关性。采用多因素Logistic回归分析法分析心脏瓣膜置换术患者预后的影响因素。绘制受试者工作特征(ROC)曲线分析血清脂联素、FGF23水平对心脏瓣膜置换术患者预后的预测价值。
结果研究组血清FGF23、NT-proBNP水平、APACHE Ⅱ评分高于对照组，血清脂联素水平低于对照组，差异有统计学意义(P < 0.05)。预后不良组血清FGF23、NT-proBNP水平和APACHE Ⅱ评分高于预后良好组，血清脂联素水平低于预后良好组，差异有统计学意义(P < 0.05)。患者的血清FGF23水平与NT-proBNP水平、APACHE Ⅱ评分呈正相关(P < 0.05)。血清脂联素水平与NT-proBNP水平、APACHE Ⅱ评分呈负相关(P < 0.05)。血清脂联素、FGF23、NT-proBNP水平和APACHE Ⅱ评分为心脏瓣膜置换术患者预后的影响因素(P < 0.05)。血清脂联素、FGF23单独预测和联合预测心脏瓣膜置换术患者预后的曲线下面积(AUC)分别为0.862、0.807、0.911。脂联素、FGF23联合预测的AUC大于单独预测，差异有统计学意义(P < 0.05)。
结论血清脂联素、FGF23联合预测心脏瓣膜置换术患者预后的效果较好。血清脂联素、FGF23有望成为评估心脏瓣膜置换术患者预后效果的有效指标。

Abstract:
Objective To investigate the prognostic value of serum adiponectin and fibroblast growth factor-23 (FGF23) levels in patients undergoing cardiac valve replacement.
Methods A total of 98 patients undergoing heart valve replacement were selected as the study group. The patients in the study group were divided into good prognosis group (n=67) and poor prognosis group (n=31). A total of 90 healthy subjects were selected as control group. Spearman method was used to analyze the correlation of serum adiponectin and FGF23 levels with plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and Acute Physiology and Chronic Health EvaluationⅡ (APACHE Ⅱ) scores, respectively. Multivariate Logistic regression analysis was used to analyze the prognostic factors of patients with heart valve replacement. Receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of serum adiponectin and FGF23 levels in patients with heart valve replacement.
Results Serum FGF23, NT-proBNP level and APACHEⅡ score in the study group were significantly higher, and serum adiponectin level was significantly lower than that in the control group (P < 0.05). The levels of serum FGF23, NT-proBNP and APACHE Ⅱ score in the poor prognosis group were significantly higher, and the serum adiponectin level was significantly lower than that in the good prognosis group (P < 0.05). Serum FGF23 level was positively correlated with NT-proBNP level and APACHE Ⅱ score (P < 0.05). Serum adiponectin level was negatively correlated with NT-proBNP level and APACHE Ⅱ score (P < 0.05). The levels of serum adiponectin, FGF23, NT-proBNP and APACHE Ⅱ score were the influencing factors for the prognosis of patients with heart valve replacement (P < 0.05). The area under the curve (AUC) of serum adiponectin and FGF23 for predicting the prognosis of patients undergoing cardiac valve replacement was 0.862 and 0.807, respectively, and the AUC of the combined prediction was 0.911. The AUC of combined prediction of adiponectin and FGF23 was higher than that of individual prediction (P < 0.05).
Conclusion The combination of serum adiponectin and FGF23 has a good effect in predicting the prognosis of patients with heart valve replacement. Serum adiponectin and FGF23 are expected to be effective indicators for evaluating the prognosis of patients undergoing heart valve replacement.

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