IGF-1、IL-17水平与老年慢性充血性心力衰竭患者不同营养状态的关系

Relationship between IGF-1,IL-17 levels and different nutritional status in elderly patients with chronic congestive heart failure

目的探讨老年慢性充血性心力衰竭(CHF)患者胰岛素样生长因子-1(IGF-1)、白介素-17(IL-17)水平与其营养状态的相关性。方法将200例入选的CHF患者根据微型营养评估法(MNA)分为营养正常组(n=62)及营养不良组(n=138),分别测定两组患者的血清IGF-1、IL-17水平及营养相关指标,比较各组间的差异,分析IGF-1、IL-17与MNA评分之间的相关性,并利用受试者工作曲线(ROC)评估IGF-1、IL-17对CHF患者发生营养不良的预测价值。结果与营养正常组比较,营养不良组患者体质指数(BMI)、白蛋白(ALB)、前白蛋白(PA)、血红蛋白(Hb)及IGF-1水平均显著降低,而年龄、IL-17水平显著升高(P<0.05)。Pearson相关性分析示,BMI指数、ALB、PA、Hb及IGF-1与MNA评分呈正相关(P<0.05),年龄、IL-17水平与MNA评分呈负相关(P<0.05)。Logistic回归分析显示ALB(OR=0.471,95%CI:0.248~0.894,P<0.05)、PA(OR=0.361,95%CI:0.156~0.839,P<0.05)、IGF-1(OR=0.071,95%CI:0.015~0.453,P<0.05)水平是影响患者发生营养不良的独立保护因素,IL-17水平是影响患者发生营养不良的独立危险因素。IGF-1预测老年CHF患者发生营养不良的ROC曲线下面积分别为0.851,最佳截断值为266.50(敏感度:81.9%;特异性:77.4%);IL-17预测老年CHF患者发生营养不良的ROC曲线下面积为0.767,最佳截断值为14.85(敏感度:67.4%;特异性:71.0%)。结论IGF-1及IL-17均与MNA评分具有一定的相关性,两者对反映老年CHF患者营养状态具有一定的临床价值。

Objective To investigate the correlation between IGF-1 and IL-17 levels and nutritional status in elderly patients with chronic congestive heart failure(CHF).Methods 200 cases of patients with CHF divided into normal nutrition group(n=62)and malnutrition group(n=138)based on mini nutritional assessment(MNA),2 groups of patients were separately measured serum IG-1,IL-17 levels and nutrition-related indicators.The differences among the groups were compared,the correlation between IGF-1,IL-17 and MNA score was analyzed,and the predictive value of IGF-1 and IL-17 for malnutrition in CHF patients was evaluated by receiver operating characteristic(ROC).Results Compared with the normal nutrition group,BMI,ALB,PA,Hb and IGF-1 levels in the malnutrition group were significantly decreased,while age and IL-17 levels were significantly increased(P<0.05).Pearson correlation analysis showed that BMI,ALB,PA,Hb and IGF-1 were positively correlated with MNA score(P<0.05),age and IL-17 level were negatively correlated with MNA score(P<0.05).Binary Logistic regression analysis showed that ALB(OR=0.471,95%CI:0.248~0.894,P<0.05),PA(OR=0.361,95%CI:0.156~0.839,P<0.05)and IGF-1(OR=0.071,95%CI:0.015~0.453,P<0.05)levels were independent protective factors affecting the occurrence of malnutrition,and IL-17 level was an independent risk factor affecting the occurrence of malnutrition.The area under curve for IGF-1 to predict malnutrition in elderly CHF patients was 0.851,and the optimal cut-off value was 266.50(sensitivity:81.9%;specificity:77.4%);The area under curve of IL-17 predicting malnutrition in elderly CHF patients was 0.767,and the optimal cut-off value was 14.85(sensitivity:67.4%;Specificity:71.0%).Conclusion Both IGF-1 and IL-17 have a certain correlation with MNA score,and they have a certain clinical value in reflecting the nutritional status of elderly CHF patients.