慢性心力衰竭患者血清成纤维生长因子21水平变化及临床意义

Changes and Clinical Significance of Serum Fibroblast Growth Factor 21 in Patients with Chronic Heart Failure

摘要: 目的：探讨慢性心力衰竭(CHF)患者血清成纤维生长因子21 (FGF21)水平变化情况及临床意义。方法：选取2019年5月~2020年1月我院收治的72例慢性心力衰竭患者作为病例组，并进行NYHA心功能分级，其中心功能II级、心功能III级、心功能IV级患者分别为20例、22例、30例，选取同期体检的54例健康者作为对照组。收集各组患者临床基线资料，采取酶联免疫吸附试验法(ELISA)测定血清FGF21水平，并通过心脏超声测定左室射血分数(LVEF)。结果：血清FGF21水平在CHF组[(330.07 ± 91.98) pg/ml]明显高于对照组[(195.64 ± 27.08) pg/ml]，差异有统计学意义(P < 0.05)；CHF组不同NYHA心功能分级患者之间血清FGF21水平差异有统计学意义(P < 0.05)，即：心功能IV级[(399.24 ± 75.94) pg/ml] > 心功能III级[(314.93 ± 61.96) pg/ml] > 心功能II级[(242.96 ± 52.56) pg/ml]。Pearson相关分析显示：CHF组患者血清FGF21水平与NT-proBNP呈正相关(r = 0.534, P < 0.01)，与LVEF呈负相关(r = −0.723, P < 0.01)。ROC曲线分析示：血清FGF21用于诊断CHF时曲线下面积为0.902，此时FGF21的截断值为251.52 pg/ml，对应的灵敏度和特异度分别为80.6%、92.1%。结论：CHF患者血清FGF21水平显著升高，且升高程度与慢性心力衰竭严重程度呈正相关，有可能成为诊断慢性心力衰竭的新型生物学标志物。

Abstract: Objective: To investigate the changes and clinical significance of serum fibroblast growth factor 21 (FGF21) in patients with chronic heart failure (CHF). Methods: 72 patients with chronic heart failure treated in our hospital from May 2019 to January 2020 were selected as the case group, and NYHA cardiac function classification was performed. There were 20, 22 and 30 patients with cardiac function grade II, III and IV respectively, and 54 healthy subjects who underwent physical examination in the same period were selected as the control group. The clinical baseline data of patients in each group were collected, the serum FGF21 level was measured by enzyme-linked immunosorbent assay (ELISA), and the left ventricular ejection fraction (LVEF) was measured by cardiac ultrasound. Results: The serum FGF21 level in the CHF group [(330.07 ± 91.98) pg/ml] was significantly higher than that in the control group [(195.64 ± 27.08) pg/ml]. There were significant differences in serum FGF21 levels among patients with different NYHA cardiac function grades in the CHF group, that is, cardiac function grade IV [(399.24 ± 75.94) pg/ml] > cardiac function grade III [(314.93 ± 61.96) pg/ml] > cardiac function grade II [(242.96 ± 52.56) pg/ml]. Pearson correlation analysis showed that the level of serum FGF21 in the CHF group was positively correlated with NT-proBNP (r = 0.534, P < 0.01), and negatively correlated with LVEF (r = 0.723, P < 0.01). ROC curve analysis showed that when serum FGF21 was used to diagnose CHF, the area under the curve was 0.902, and the cutoff value of FGF21 was 251.52 pg/ml, and the corresponding sensitivity and specificity were 80.6% and 92.1%, respectively. Conclusion: The level of serum FGF21 in patients with CHF is significantly increased, and the degree of increase is positively correlated with the severity of chronic heart failure, which may become a new biological marker for the diagnosis of chronic heart failure.