血清胰岛素样生长因子-1对钙化性主动脉瓣狭窄及左室重构的影响

Effects of serum insulin-like growth factor-1 on calcific aortic valve stenosis and left ventricular remodeling

目的 探讨血清胰岛素样生长因子-1（IGF-1）对钙化性主动脉瓣狭窄程度及左室重构的影响及临床意义.方法 选取钙化性主动脉瓣狭窄患者60例和健康体检者20例,根据主动脉瓣狭窄程度（A、B、C）和左室构型[左室正常构型（LVN）、向心性重构（LVCR）、向心性肥厚（LVCH）、离心性肥厚（LVEH）]分组.用实时三维超声心动图（RT-3DE）分析左室射血分数（LVEF）、左室舒张末期容积（LEDV）、左室质量指数（LVMI）和左室重构指数（LVRI）,用酶联免疫吸附法（ELISA）测血清IGF-1浓度.多组间均数比较用单因素方差分析,相关性分析用Pearson分析法.结果 （1）A、B、C、D组血清IGF-1浓度分别为（97.1±13.9）、（115.9±25.8）、（117.3±42.8）、（72.25±11.1）ng/ml,A、B、C均显著高于对照组（P＜0.05）,B、C组高于A组（P＜0.05）,但B、C组之间差异无统计学意义（P＞0.05）.（2） LVCR、LVCH、LVEH组和LVN组血清IGF-1浓度分别为（112.6±51.9）、（135.6 ±42.8）、（127.7±41.2）、（81.5±22.5）ng/ml,前3组均显著高于LVN组（P＜0.05）,LVN组与对照组[IGF-1：（72.3±11.1） ng/ml]差异无统计学意义（P＞0.05）,LVCR组高于LVN组而低于LVCH和LVEH组（P＜0.05）,LVCH组和LVEH组之间差异无统计学意义（P＞0.05）.（3） IGF-1与LVMI和LVRI呈正相关（r=0.570,P＜0.01;r=0.682,P＜0.01）.结论 IGF-1促进主动脉瓣钙化,在左室重构中起重要作用.

Objective To explore the effects of serum insulin-like growth factor-1 （IGF-1） on patients with calcific aortic valve stenosis and left ventricular remodeling and its clinical significance.Methods Sixty patients and 20 healthy people were included.The baseline clinical data and echocardiographic indexes were collected.left ventricular ejection fraction （LVEF）,left ventricular end diastolic diameter （LVEDD）,left ventricular end diastolic volume （LEDV）,left ventricular mass index （LVMI） and left ventricular remodeling index （LVRI） were calculated by real-time three-dimensional echocardiographic （RT-3DE）.Serum level of IGF-1 was measured by enzyme linked immunosorbent assay （ELISA）.Firstly,the patients were classified into three categories according to mild,medium or severe stenosis （A,B,C）.Then,these patients were divided into four groups according to RWT and LVMI：normal left ventricular geometry （LVN）,concentric remodeling （LVCR）,concentric hypertrophy （LVCH） and eccentric hypertrophy （LVEH）.The multiple mean was compared by one-way ANOV,and the correlational analyses were conducted by Pearson correlation.Results （1） Serum IGF-1 level was significantly higher in groups A,B,and C [（97.1 ± 13.9）,（115.9 ±25.8）,（117.3 ±42.8） ng/ml respectively] than in control group [D,IGF-1：（72.3 ±11.1） ng/ml,P〈0.05],and that in groups B and C was higher than in group A （P 〈 0.05）,but there was no significant difference between groups B and C （P 〉 0.05）.（2） IGF-1 levels in LVCR,LVCH,and LVEH groups wer significantly higher than in LVN group [（112.6±51.9）,（135.6 ±42.8）,（127.7 ±41.2） and （81.5 ±22.5） ng/ml respectively,P〈 0.05],but those in LVN group showed no statistically significant difference from the controls （P 〉 0.05）.IGF-1 levels in LVCR group was significantly higher than in LVN group and lower than in LVCH and LVEH groups （P 〈 0.05）,but there was no significant difference between LVCH group and LVEH group （P 〉 0.05）.（3） There was a positive correlation between IGF-1 and LVMI （r =0.570,P 〈 0.01）,LVRI （r =0.682,P 〈 0.01）.Conclusion IGF-1 may play a positive role in aortic valve calcification and left ventricular remodeling.