血清成纤维细胞生长因子23和胎盘生长因子水平变化对老年冠心病患者经皮冠状动脉介入治疗术后并发心力衰竭的预测价值

The value of serum fibroblast growth factor 23 and placental growth factor levels in predicting heart failure after percutaneous coronary intervention in elderly patients with coronary artery heart disease

目的探讨血清成纤维细胞生长因子23(fibroblast growth factor 23,FGF23)和胎盘生长因子(placental growth factor,PLGF)水平变化对老年冠心病患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后并发心力衰竭(心衰)的预测价值。方法选取2015年4月至2017年1月江苏省人民医院收治的接受PCI的老年冠心病患者120例为研究对象,术后随访2年。按照是否发生心衰将入选患者分为心衰组(65例)和无心衰组(55例)。采用酶联免疫吸附测定检测两组患者出院时血清FGF23和PLGF水平。采用Spearman相关系数分析血清FGF23和PLGF水平与左室射血分数(left ventricular ejection fraction,LVEF)和左室收缩末期内径(left ventricular end-systolic diameter,LVESD)的相关性,采用Cox回归模型分析老年冠心病患者PCI术后并发心衰的影响因素,根据预测概率绘制受试者操作特征曲线(receiver operator characteristic curve,ROC曲线),分析血清FGF23和PLGF水平对老年冠心病患者PCI术后并发心衰的预测价值。结果入院时,两组患者血清FGF23和PLGF水平比较差异均无统计学意义(均P>0.05);出院前,心衰组患者血清FGF23和PLGF水平均显著高于无心衰组(均P<0.05)。行PCI的老年冠心病患者出院前血清FGF23和PLGF水平与LVEF均呈显著负相关(均P<0.05),与LVESD和纽约心脏协会(New York Heart Association,NYHA)心功能分级均呈显著正相关(均P<0.05)。LVEF、LVESD、NYHA心功能分级、出院前血清FGF23和PLGF水平均是影响老年冠心病患者PCI术后并发心衰的独立危险因素(P<0.001)。ROC曲线分析显示出院前血清FGF23和PLGF联合预测老年冠心病患者PCI术后并发心衰的灵敏度和特异度分别为92.50%和82.00%。结论PCI术后并发心衰的老年冠心病患者出院前血清FGF23和PLGF表达上调,可将其作为评估预后的可靠指标。

Objective To investigate the value of serum fibroblast growth factor 23(FGF23)and placental growth factor(PLGF)levels in predicting heart failure after percutaneous coronary intervention(PCI)in elderly patients with coronary artery heart disease(CHD).Method A total of 120 elderly patients with CHD who underwent PCI who were admitted to the Jiangsu Province People's Hospital from April 2015 to January 2017 were selected as the research objects.They were followed up for 2 years after the operation.According to whether heart failure occurred,they were divided into heart failure group(65 cases)and non-heart failure group(55 cases).Enzyme-linked immunosorbent assay was used to determine the serum FGF23 and PLGF expression levels of patients in the two groups at discharge.Spearman correlation coefficient was used to analyze the correlation between serum FGF23 and PLGF expression and left ventricular ejection fraction(LVEF)and left ventricular end-systolic diameter(LVESD),and Cox regression model was used to analyze the influencing factors of heart failure after PCI in elderly patients with CHD.The receiver operator characteristic curve(ROC curve)was used to analyze the predictive value of serum FGF23 and PLGF levels for heart failure after PCI in elderly patients with CHD.Result There were no significant differences in serum FGF23 and PLGF levels between the two groups on admission(all P>0.05).Before discharge,the serum FGF23 and PLGF levels in heart failure group were significantly higher than those in non-heart failure group(all P<0.05).Before discharge,the levels of serum FGF23 and PLGF in elderly patients with CHD underwent PCI were negatively correlated with LVEF(all P<0.05),and positively correlated with LVESD and New York Heart Association(NYHA)cardiac function classification(all P<0.05).LVEF,LVESD,NYHA ardiac function classification,serum FGF23 and PLGF levels before discharge were independent risk factors affecting heart failure after PCI in elderly patients with CHD(all P<0.001).ROC curve analysis showed that the sensitivity and specificity of serum FGF23 and PLGF before discharge combined to predict heart failure after PCI in elderly patients with CHD were 92.50%and 82.00%,respectively.Conclusion The expression of serum FGF23 and PLGF before discharge are up-regulated in elderly patients with CHD who develop heart failure after PCI,which can be used as reliable indicators of prognosis.