肾心综合征患者病情严重程度与血清BNP及FGF-23水平的关系

Relationship between the severity of renocardiac syndrome and serum BNP and FGF-23 levels

目的探讨肾心综合征患者病情严重程度与血清脑钠肽(BNP)、成纤维细胞生长因子23(FGF-23)水平的关系。方法选取2021年1月至2023年3月聊城市第二人民医院收治的60例肾心综合征患者纳为观察组,另选取同期25例健康体检者纳为对照组以及15例慢性肾病患者纳为慢性肾病组。观察组男33例、女27例,年龄(68.79±8.58)岁;对照组男13名、女12名,年龄(69.48±8.11)岁;慢性肾病组男9例、女6例,年龄(70.12±8.09)岁。检测并比较3组研究对象血清BNP、FGF-23水平(经方差分析),通过受试者工作特征曲线(ROC)分析血清BNP、FGF-23水平预测肾心综合征患者病情严重程度的价值,同时比较不同心功能分级及肾功能分期肾心综合征患者血清BNP、FGF-23水平(经方差分析),通过Spearman秩相关分析血清BNP、FGF-23水平与肾功能分期及心功能分级的相关性。结果观察组血清BNP、FGF-23水平[(456.48±64.48)mmol/L、(61.15±5.15)ng/L]均高于慢性肾病组[(248.89±54.47)mmol/L、(47.48±4.78)ng/L]及对照组[(75.52±10.45)mmol/L、(30.44±4.49)ng/L],差异均有统计学意义(F=448.625、346.409,均P<0.001)。经ROC分析证实,血清BNP、FGF-23水平可预测肾心综合征患者病情严重程度,曲线下面积为0.690、0.941(均P<0.05)。心功能Ⅱ级患者血清BNP、FGF-23水平[(346.48±34.14)mmol/L、(68.14±5.46)ng/L]均显著低于心功能Ⅲ级患者[(651.15±86.15)mmol/L、(72.18±6.48)ng/L]及心功能Ⅳ级患者[(819.15±94.58)mmol/L、(81.15±6.79)ng/L],差异均有统计学意义(F=180.981、19.070,均P<0.001)。肾功能Ⅰ期患者血清BNP、FGF-23水平[(348.48±32.45)mmol/L、(68.45±5.48)ng/L]均显著低于肾功能Ⅱ期患者[(456.18±45.15)mmol/L、(74.45±6.15)ng/L]、肾功能Ⅲ期患者[(784.15±56.15)mmol/L、(78.15±6.89)ng/L]及肾功能Ⅳ期患者[(826.45±64.15)mmol/L、(86.15±6.89)ng/L],差异均有统计学意义(F=327.325、20.322,均P<0.001)。血清BNP、FGF-23水平与肾功能分期及心功能分级均呈正相关(均P<0.05)。结论血清BNP、FGF-23水平与肾心综合征患者肾功能分期及心功能分级均呈正相关,临床医师应对上述指标密切监测,以预测疾病发生与进展。

Objective To investigate the relationship between the severity of renocardiac syndrome and serum levels of brain natriuretic peptide(BNP)and fibroblast growth factor 23(FGF-23).Methods A total of 60 patients with renocardiac syndrome admitted to Liaocheng Second People's Hospital from January 2021 to March 2023 were selected as the observation group,and 25 healthy individuals who underwent physical examination during the same period as the control group and 15 patients with chronic kidney disease as the chronic kidney disease group.In the observation group,there were 33 males and 27 females,aged(68.79±8.58)years.In the control group,there were 13 males and 12 females,aged(69.48±8.11)years.In the chronic kidney disease group,there were 9 males and 6 females,aged(70.12±8.09)years.Serum BNP and FGF-23 levels were detected and compared among the 3 groups by variance analysis,and the values of serum BNP and FGF-23 levels in predicting the severity of renocardiac syndrome were analyzed by receiver operating characteristic curve(ROC).Serum levels of BNP and FGF-23 were compared in patients with renocardiac syndrome with different cardiac function grading and renal function grading by variance analysis,and the correlations between serum BNP and FGF-23 levels and renal function grading and cardiac function grading were analyzed by Spearman rank correlation analysis.Results Serum levels of BNP and FGF-23[(456.48±64.48)mmol/L and(61.15±5.15)ng/L]in the observation group were higher than those in the chronic kidney disease group[(248.89±54.47)mmol/L and(47.48±4.78)ng/L]and the control group[(75.52±10.45)mmol/L and(30.44±4.49)ng/L],with statistically significant differences(F=448.625 and 346.409,both P<0.001).ROC analysis confirmed that serum levels of BNP and FGF-23 could predict the severity of renocardiac syndrome,with the areas under the curve of 0.690 and 0.941(both P<0.05).Serum levels of BNP and FGF-23[(346.48±34.14)mmol/L and(68.14±5.46)ng/L]in the patients with gradeⅡcardiac function were significantly lower than those in the patients with gradeⅢcardiac function[(651.15±86.15)mmol/L and(72.18±6.48)ng/L]and gradeⅣcardiac function[(819.15±94.58)mmol/L and(81.15±6.79)ng/L],with statistically significant differences(F=180.981 and 19.070,both P<0.001).Serum levels of BNP and FGF-23[(348.48±32.45)mmol/L,(68.45±5.48)ng/L]in the patients with stage I renal function were significantly lower than those in the patients with stage II renal function[(456.18±45.15)mmol/L and(74.45±6.15)ng/L],stage III renal function[(784.15±56.15)mmol/L and(78.15±6.89)ng/L],and stage IV renal function[(826.45±64.15)mmol/L and(86.15±6.89)ng/L],with statistically significant differences(F=327.325 and 20.322,both P<0.001).Serum levels of BNP and FGF-23 were positively correlated with renal function grading and cardiac function grading(all P<0.05).Conclusions Serum levels of BNP and FGF-23 are positively correlated with renal function grading and cardiac function grading in patients with renocardiac syndrome.Clinicians should closely monitor these indicators to predict the occurrence and progression of the disease.