血清CTRP3、IGF-1预测老年甲状腺功能亢进患者房颤的价值研究

Study on serum CTRP3 and IGF-1 in the predictive value of atrial fibrillation in elderly patients with hyperthyroidism

目的探讨血清脂肪因子补体C1q肿瘤坏死因子相关蛋白3(CTRP3)、胰岛素样生长因子-1(IGF-1)对老年甲状腺功能亢进(简称甲亢)患者心房颤动(简称房颤)发生的预测效能。方法前瞻性选取该院2018年1月至2020年1月确诊并接受治疗的85例老年甲亢患者作为研究对象,于治疗前收集基线资料,检测血清甲状腺激素[促甲状腺激素(TSH)、游离甲状腺素(FT_(4))、游离三碘甲状腺原氨酸(FT_(3))]、CTRP3、IGF-1水平,测定心功能[左室射血分数(LVEF)、室间隔厚度(IVST)],记录患者治疗6个月内房颤发生情况,并根据房颤发生情况将患者分为房颤组和无房颤组。比较两组基线资料,血清甲状腺激素、CTRP3、IGF-1水平,以及LVEF、IVST。采用Logistic回归模型分析血清CTRP3、IGF-1水平与老年甲亢患者房颤发生的关系,采用受试者工作特征(ROC)曲线分析血清CTRP3、IGF-1单独和联合检测对老年甲亢患者房颤发生风险的预测效能。结果85例老年甲亢患者中房颤组13例,无房颤组72例。两组基线资料、血清TSH、FT、FT水平及LVEF、IVST比较,差异均无统计学意义(P>0.05);房颤组血清CTRP3水平低于无房颤组,而IGF-1水平高于无房颤组,差异均有统计学意义(P<0.05)。Logistic回归模型分析显示,低水平的CTRP3和高水平的IGF-1可能是房颤发生的独立危险因素(OR>1,P<0.05)。ROC曲线分析结果显示,血清CTRP3、IGF-1单独及联合检测预测老年甲亢患者房颤发生风险的曲线下面积分别为0.808、0.815、0.830(P<0.05)。结论老年甲亢患者CTRP3水平降低,IGF-1水平升高,低水平CTRP3及高水平IGF-1可能是房颤发生的独立危险因素,可将它们用于预测老年甲亢患者治疗期间房颤发生的风险。

Objective To investigate the predictive effect of serum adipokine complement C1 q tumor necrosis factor-related protein 3(CTRP3) and insulin-like growth factor-1(IGF-1) on the occurrence of atrial fibrillation in elderly patients with hyperthyroidism.Methods A total of 85 elderly patients with hyperthyroidism diagnosed and treated in this hospital from January 2018 to January 2020 were prospectively selected as research subjects.Baseline data were collected before treatment, and serum levels of thyroid hormones [thyroid-stimulating hormone(TSH),free thyroxine(FT_(4)),free triiodothyronine(FT_(3))],CTRP3 and IGF-1 were detected, cardiac function [left ventricular ejection fraction(LVEF),ventricular septal thickness(IVST)] was measured.The occurrence of atrial fibrillation within 6 months of treatment was recorded, and patients were divided into the atrial fibrillation group and the non-atrial fibrillation group according to the occurrence of atrial fibrillation.Baseline data, serum levels of thyroid hormone, CTRP3 and IGF-1,LVEF and IVST were compared between the two groups.The relationship between the serum levels of CTRP3 and IGF-1 and the occurrence of atrial fibrillation in elderly patients with hyperthyroidism was analyzed by Logistic regression model, and the predictive efficacy of serum CTRP3 and IGF-1 alone and in combination detection on the risk of the occurrence of atrial fibrillation in elderly patients with hyperthyroidism was analyzed by Receiver operating characteristic(ROC) curve.Results Among the 85 elderly patients with hyperthyroidism, 13 cases were in the atrial fibrillation group, and 72 cases were in the non-atrial fibrillation group.There were no statistically significant differences in the baseline data, the serum levels of TSH,FTand FT,LVEF and IVST between the two groups(P>0.05);the serum level of CTRP3 in the atrial fibrillation group was lower than that in the atrial fibrillation group, while the IGF-1 level in the atrial fibrillation group was higher than that in the atrial fibrillation group, and the differences were all statistically significant(P<0.05).Logistic regression model analysis showed that low level of CTRP3 and high level of IGF-1 may be independent risk factors for the occurrence of atrial fibrillation(OR>1,P<0.05).ROC curve analysis showed that the areas under the curve of serum CTRP3,IGF-1 alone and combination detection for predicting the risk of the occurrence of atrial fibrillation in elderly patients with hyperthyroidism were 0.808,0.815 and 0.830,respectively(P<0.05).Conclusion The level of CTRP3 decreases, and the level of IGF-1 increases in elderly patients with hyperthyroidism.Low level of CTRP3 and high level of IGF-1 may be independent risk factors for the occurrence of atrial fibrillation.They can be used to predict the risk of the occurrence of atrial fibrillation in elderly patients with hyperthyroidism during treatment.