血清成纤维细胞生长因子23对经皮冠状动脉介入治疗后心血管不良事件的预测价值

Forecasting value of serum fibroblast growth factor 23 for cardiovascular adverse events after percutaneous coronary intervention in acute coronary syndrome

目的探讨血清成纤维细胞生长因子23(FGF23)对急性冠状动脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)后主要心血管不良事件(MACE)的预测价值。方法选取2017年6月至2019年6月在湖北省天门市第一人民医院行PCI治疗的105例ACS患者作为研究对象,按照是否发生MACE分为MACE组32例和非MACE组73例。比较两组患者一般资料、超声指标、生化指标的差异,Logistic回归分析ACS患者PCI后发生MACE的独立危险因素,利用受试者工作特征(ROC)曲线分析相关指标对ACS患者术后发生MACE的预测价值。结果两组患者年龄、性别构成等一般资料比较差异无统计学意义(P>0.05)。MACE组全球急性冠状动脉事件注册危险(GRACE)评分明显高于非MACE组[(119.18±11.49)分比(111.57±9.31)分](P<0.05);与非MACE组比较,MACE组左心室舒张末内径(LVEDD)、脑钠肽(BNP)、C反应蛋白(CRP)、FGF23明显升高,左心室射血分数(LVEF)显著降低[(52.04±0.34)mm比(48.57±3.69)mm、(509.48±52.08)ng/L比(474.68±89.27)ng/L、(9.61±2.06)mg/L比(7.85±0.83)ng/L、(504.73±82.27)ng/L比(331.99±81.68)ng/L、(34.77±2.93)%比(37.80±3.62)%](P<0.05)。Logistic多因素回归分析显示,LVEF、CRP、FGF23是ACS患者PCI后发生MACE的独立危险因素(P均<0.05)。ROC曲线分析显示,LVEF预测ACS患者PCI术后发生MACE事件曲线下面积(AUC)为0.747,CRP、FGF23为0.772、0.944,FGF23明显高于LVEF、CRP(Z=3.867、2.698,P<0.05)。结论血清FGF23异常升高与ACS患者PCI后MACE有关,可作为早期评估患者心血管不良预后的血清指标。

Objective To investigate the forecasting value of serum fibroblast growth factor 23(FGF23)for major adverse cardiovascular adverse events(MACE)after percutaneous coronary intervention(PCI)in acute coronary syndrome(ACS).Methods One hundred and five patients with ACS who underwent PCI in the First People′s Hospital of Tianmen City from June 2017 to June 2019 were enrolled.According to the happening of a MACE event occurs,the patients were divided into the MACE group(32 cases)and the non-MACE group(32 cases).The differences of general data,ultrasound indicators and biochemical indicators of patients between the two groups were compared.Logistic regression analysis was used to analyze independent risk factors for MACE after PCI in patients with ACS.Receiver operating characteristic(ROC)curve analysis was used to predict the predictive value of postoperative MACE in patients with ACS.Results There were no significant difference in the comparison of general data such as age and gender between the two groups(P>0.05).The Global Registered Risk of Acute Coronary Events(GRACE)score in the MACE group was significantly higher than that in the non-MACE group[(119.18±11.49)scores vs.(111.57±9.31)scores,P<0.05].Compared with the non-MACE group,the left ventricular end diastolic diameter(LVEDD),brain natriuretic peptide(BNP),C-reactive(CRP),and FGF23 in the MACE group were significantly increased,and the left ventricular ejection fraction(LVEF)was significantly decreased[(52.04±3.43)mm vs.(48.57±3.69)mm,(509.48±52.08)ng/L vs.(474.68±89.27)ng/L,(9.61±2.06)mg/L vs.(7.85±0.83)mg/L,(504.73±82.27)ng/L vs.(331.99±81.68)ng/L,(34.77±2.93)%vs.(37.80±3.62)%](P<0.05).Logistic multivariate regression analysis showed that LVEF,CRP,and FGF23 were independent risk factors for MACE after PCI in patients with ACS(P<0.05).ROC curve analysis showed that AUC of LVEF that predicted for MACE after PCI in patients with ACS was 0.747,and AUC of CRP and FGF23 were 0.772 and 0.944.The AUC of FGF23 was significantly higher than that of LVEF and CRP(Z=3.867,2.698,P<0.05).Conclusions Abnormal elevation of serum FGF23 is associated with cardiovascular adverse events after PCI in patients with ACS,which can be used as a serum indicator for early assessment of poor cardiovascular outcomes in patients.