体外心肺复苏成功后患者血清GH IGF-1水平与HOMA-IR的相关性研究及生存结局影响因素分析

The correlation of GH and IGF-1 levels with HOMA-IR in patients after successful extracorporeal cardiopulmonary resuscitation and influencing factors of survival outcomes

目的探讨体外心肺复苏成功后患者血清生长激素(GH)、胰岛素样生长因子-1(IGF-1)水平与胰岛素抵抗指数(HOMA-IR)的相关性,并分析患者生存结局影响因素。方法将80例体外心肺复苏成功后患者设为观察组,选取同期80名健康体检志愿者设为对照组。根据28 d生存结局,将观察组患者分为死亡组49例和生存组31例。收集受试者一般资料,采用电化学发光法和高效液相色谱质谱法分别检测受试者血清中GH、IGF-1水平,采用Pearson相关检验分析GH、IGF-1与糖、脂代谢指标的相关性,采用Logistic回归分析体外心肺复苏成功后患者生存结局的影响因素。结果观察组受试者血清空腹血糖(FBG)、空腹胰岛素(FINS)、HOMA-IR、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、GH水平均高于对照组,高密度脂蛋白胆固醇(HDL-C)、IGF-1水平均低于对照组(P<0.01);观察组患者血清GH与IGF-1水平呈显著负相关(r=-0.518,P<0.01);观察组患者血清GH水平与FBG、FINS、HOMA-IR、HbA1c、TC、TG、LDL-C水平呈显著正相关,与HDL-C水平呈显著负相关(P<0.01);血清IGF-1水平与FBG、FINS、HOMA-IR、HbA1c、TC、TG、LDL-C水平呈显著负相关,与HDL-C水平呈显著正相关(P<0.01)。死亡组患者血清FBG、HOMA-IR、HbA1c、GH水平均高于生存组,IGF-1水平低于生存组(P<0.05或0.01)。Logistic回归分析显示GH、IGF-1、HOMA-IR均是体外心肺复苏成功后患者死亡的影响因素(P<0.01)。结论体外心肺复苏成功后患者血清GH水平升高,IGF-1水平降低,导致其HOMA-IR升高,血糖、血脂代谢紊乱,影响患者生存结局。

Objective To explore the cor relation of serum growth hormone(GH)and insulin-like growth factor-1(IGF-1)level with insulin resistance index(HOMA-IR)in patients after successful extracorporeal cardiopulmonary resuscitation(ECPR)and analyze the influencing factors of survival outcomes.Methods Eighty patients with successful ECPR were set as observation group and 80 health check-up volunteers as control group in the same period.According to 28 day survival outcomes patients in observation group were divided into death(n=49)and survival(n=31)group.General information was collected,serum GH and IGF-1 level measured using electrochemiluminescence and high performance liquid chromatography mass spectrometry respectively,the cor relations of GH and IGF-1 with the metabolic indexes of glucose and lipid analyzed using Pearson correlation analysis,and the influencing factors of patients'surviva l outcomes done using Logistic regression.Results Fasting blood glucose(FBG),fasting insulin(FINS),HOMAIR,glycosylated hemoglobin(HbA1c),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)and GH level were all higher and high density lipoprotein cholesterol(HDL-C)and IGF-1 lower in observation than control group(P<0.01);serum GH levels were significantly negatively correlated with IGF-1 in observation group(r=-0.518,P<0.01);serum GH levels were significantly positively correlated with FBG,FINS,HOMA-IR,HbA1c,TC,TG,and LDL-C and negatively with HDL-C in observation group(P<0.01);the serum IGF-1 levels were significantly negatively correlated with FBG,FINS,HOMA-IR,HbA1c,TC,TG,and LDL-C and positively with HDL-C(P<0.01);serum FBG,HOMA-IR,HbA1c,and GH levels were higher and IGF-1 was lower in death than survival group(P<0.05 or 0.01).Logistic regression analysis shows that GH,IGF-1,and HOMA-IR were all influencing factors of patients'death after successful ECPR(P<0.01).Conclusion Serum GH levels increase and IGF-1 lower in patients after successful ECPR,which leads to the increase of HOMA-IR and the disturbances of glucose and lipid metabolism,and influence patients'survival outcomes.