老年慢性心力衰竭患者血清中胰岛素样生长因子-1和肾损伤分子-1表达水平变化及对预后的影响

Changes of serum insulin-like growth factor-1 and kidney injury molecule-1 levels in elderly patients with chronic heart failure and their influence on prognosis

目的探讨血清胰岛素样生长因子-1(IGF-1)、肾损伤分子-1(KIM-1)在老年慢性心力衰竭患者中的表达水平变化及对预后的影响。方法选择2021年1月至2022年1月华中科技大学同济医学院附属梨园医院和西安医学院附属宝鸡医院收治的92例老年慢性心力衰竭患者为研究对象(病例组)。根据随访期间是否发生不良心血管事件(MACE)将患者分为MACE组(n=33)和非MACE组(n=59)。另选择50名健康体检者作为对照组。病例组患者于入院24 h内、对照组受试者于体检当日采集空腹静脉血5 mL,然后采用酶联免疫吸附法检测所有受试者血清中KIM-1、IGF-1水平,荧光免疫吸附法检测血清中N末端B型利钠肽前体(NT-proBNP)水平。病例组患者于入院后24 h内、对照组受试者于体检当日使用彩色超声诊断系统测定安静状态下左心室射血分数(LVEF)。采用Pearson相关分析老年慢性心力衰竭患者血清KIM-1、IGF-1与NT-proBNP、LVEF的相关性,绘制受试者操作特征(ROC)曲线,根据曲线下面积(AUC)评估KIM-1、IGF-1对老年慢性心力衰竭患者发生MACE的预测价值。结果病例组患者血清中KIM-1、NT-proBNP水平显著高于对照组,IGF-1水平及LVEF显著低于对照组(P<0.05)。随着NYHA分级增加,老年慢性心力衰竭患者血清中KIM-1、NT-proBNP水平逐渐增加,血清IGF-1水平及LVEF逐渐降低,不同心功能分级患者血清中KIM-1、IGF-1、NT-proBNP水平及LVEF比较差异均有统计学意义(P<0.05)。Pearson相关性分析结果显示,老年慢性心力衰竭患者血清中KIM-1水平与NT-proBNP呈正相关(r=0.696,P<0.05),与LVEF呈负相关(r=-0.643,P<0.05);血清中IGF-1水平与NT-proBNP呈负相关(r=-0.755,P<0.05),与LVEF呈正相关(r=0.698,P<0.05)。MACE组患者血清中KIM-1、NT-proBNP水平显著高于非MACE组,血清IGF-1水平及LVEF显著低于非MACE组(P<0.05)。ROC曲线分析结果显示,血清KIM-1、IGF-1预测老年慢性心力衰竭患者发生MACE的截断值分别为1327.42 ng·L^(-1)、125.31μg·L^(-1),AUC分别为0.878、0.833,灵敏度分别为78.38%、81.08%,特异度分别为80.30%、84.85%。结论老年慢性心力衰竭患者血清中KIM-1、IGF-1水平的变化与患者病情严重程度密切相关,且KIM-1、IGF-1水平对患者的预后具有较高的预测价值。

Objective To investigate the changes of serum insulin-like growth factor-1(IGF-1)and kidney injury molecule-1(KIM-1)levels in elderly patients with chronic heart failure and their influence on prognosis.Methods Ninety-two elderly patients with chronic heart failure admitted to Liyuan Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology and Affiliated Baoji Hospital of Xi′an Medical College from January 2021 to January 2022 were selected as the research objects(case group).The patients were divided into major adverse cardiovascular events(MACE)group(n=33)and non-MACE group(n=59)according to whether MACE occurred during the follow-up period.Another 50 healthy examinees were selected as the control group.The 5 mL fasting venous blood was collected from patients within 24 hours after admission in the case group and from subjects in the control group on the day of physical examination.Then the serum levels of KIM-1 and IGF-1 of all subjects were detected by enzyme-linked immunosorbent assay,and the serum level of N-terminal pro-B-type natriuretic peptide precursor(NT-proBNP)was detected by fluorescence immunosorbent assay.The left ventricular ejection fraction(LVEF)was measured by color ultrasound diagnostic system.The correlation between serum KIM-1,IGF-1 levels and NT-proBNP,LVEF in elderly patients with chronic heart failure was analyzed by Pearson correlation.The receiver operating characteristic(ROC)curve was drawn and the value of KIM-1 and IGF-1 in predicting the occurrence of MACE in elderly patients with chronic heart failure was evaluated according to the area under curve(AUC).Results The levels of serum KIM-1 and NT-proBNP of patients in the case group were significantly higher than those in the control group,and the levels of serum IGF-1 and LVEF of patients in the case group were significantly lower than those in the control group(P<0.05).With the increase of New York Heart Disease Association(NYHA)grade,the serum KIM-1,NT-proBNP levels increased,the serum IGF-1 level and LVEF decreased;the serum KIM-1,IGF-1,NT-proBNP levels and LVEF in patients with different NYHA grade were significantly different(P<0.05).Pearson correlation analysis result showed that the serum KIM-1 level was positively correlated with NT-proBNP(r=0.696,P<0.05),and was negatively correlated with LVEF(r=-0.643,P<0.05)in elderly patients with chronic heart failure;the serum IGF-1 level was negatively correlated with NT-proBNP(r=-0.755,P<0.05),and was positively correlated with LVEF(r=0.698,P<0.05).The serum KIM-1,NT-proBNP levels of patients in the MACE group were significantly higher than those in the non-MACE group,the serum IGF-1 level and LVEF were signifi cantly lower than those in the non-MACE group(P<0.05).ROC curve analysis results showed that the cut-off values of serum KIM-1 and IGF-1 levels in predicting MACE in elderly patients with chronic heart failure were 1327.42 ng·L^(-1),125.31μg·L^(-1),respectively;the AUC were 0.878 and 0.833,the sensitivity were 78.38%and 81.08%,the specificity were 80.30%and 84.85%,respectively.Conclusion The changes of serum KIM-1 and IGF-1 levels are closely related to the severity of elderly patients with chronic heart failure,and the levels of KIM-1 and IGF-1 have high predictive value for the prognosis of patients.