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急性心力衰竭患者血清胰岛素样生长因子结合蛋白-7、沉默信息调节因子4表达水平及意义

Expression and significance of serum insulin-like growth factor binding protein-7 and silencing information regulator 4 in patients with acute heart failure

    摘要
  • 摘要:
    目的 探讨胰岛素样生长因子结合蛋白-7(IGFBP-7)、沉默信息调节因子4(SIRT4)在急性心力衰竭(AHF)患者血清中的表达水平及其对预后的预测价值。
    方法 选取151例AHF患者(AHF组)和151例健康体检者(对照组)作为研究对象，检测并比较2组血清IGFBP-7、SIRT4、N-末端钠尿肽前体(NT-proBNP)和活性氧(ROS)水平。分析血清IGFBP-7、SIRT4、NT-proBNP、ROS水平与病情分级的关系; 采用Pearson相关系数法分析IGFBP-7、SIRT4与NT-proBNP、ROS的相关性; 采用多因素Logistic回归分析法分析AHF患者预后的影响因素。绘制受试者工作特征(ROC)曲线，分析血清IGFBP-7、SIRT4对AHF患者预后不良的预测效能。
    结果 AHF组血清IGFBP-7、SIRT4、NT-proBNP和ROS水平均高于对照组，差异有统计学意义(P < 0.05); AHF组患者中，病情分级Ⅳ级者血清IGFBP-7、SIRT4、NT-proBNP和ROS水平高于Ⅲ级者和Ⅱ级者，且Ⅲ级者高于Ⅱ级者，差异有统计学意义(P < 0.05); AHF组预后不良者病情分级和血清IGFBP-7、SIRT4、NT-proBNP、ROS表达水平均高于预后良好者，差异有统计学意义(P < 0.05)。AHF患者血清IGFBP-7、SIRT4水平均分别与血清NT-proBNP、ROS水平呈正相关(r=0.523、0.498、0.578、0.557, P < 0.05)。多因素Logistic回归分析显示，病情分级和血清IGFBP-7、SIRT4、NT-proBNP、ROS水平均为AHF患者预后的独立影响因素(P < 0.05)。ROC曲线显示，血清IGFBP-7、SIRT4对AHF患者预后均有一定预测价值，曲线下面积(AUC)分别为0.794、0.795, 且两者与ROS联用的预测价值更高, AUC为0.909(95%CI: 0.858~0.959)。
    结论 IGFBP-7、SIRT4在AHF患者血清中呈高表达，且其表达水平与患者病情分级和预后显著相关，两者联合检测对患者预后具有较高的预测价值。

     

    Abstract:
    Objective To investigate the expression levels of serum insulin-like growth factor binding protein-7 (IGFBP-7) and silence-information regulatory factor 4 (SIRT4) in patients with acute heart failure (AHF) and their prognostic value.
    Methods A total of 151 patients with AHF (AHF group) and 151 healthy subjects (control group) were enrolled. Serum IGFBP-7, SIRT4, N-terminal natriuretic peptide precursors (NT-proBNP) and reactive oxygen species (ROS) were detected in the two groups. The relationships of serum levels of IGFBP-7, SIRT4, NT-proBNP, ROS with clinical grade were analyzed. Pearson correlation coefficient was used to analyze the correlations of IGFBP-7 and SIRT4 with NT-proBNP and ROS. Multivariate Logistic regression analysis was used to analyze the prognostic factors of AHF patients, and the Receiver operating characteristic (ROC) curve was drawn to analyze the predictive efficacy of serum IGFBP-7 and SIRT4 on poor prognosis of AHF patients.
    Results Compared with the control group, the expression levels of IGFBP-7, SIRT4, NT-proBNP and ROS in serum of the AHF group were significantly increased (P < 0.05). The expression levels of IGFBP-7, SIRT4, NT-proBNP and ROS in the serum of patients with clinical disease grade Ⅳ were higher than that in grade Ⅲ and grade Ⅱ, and those with grade Ⅲ was significantly higher than that of grade Ⅱ (P < 0.05). The expression levels of IGFBP-7, SIRT4, NT-proBNP and ROS and severity grading in patients with poor prognosis in the AHF group were significantly higher than those in patients with good prognosis (P < 0.05). The expression levels of IGFBP-7 and SIRT4 in serum were positively correlated with the levels of NT-proBNP and ROS (r=0.523, 0.498, 0.578, 0.557, P < 0.05). Multifactor Logistic regression analysis showed that clinical grade, serum expression levels of IGFBP-7, SIRT4, NT-proBNP and ROS were independent influencing factors for prognosis of AHF (P < 0.05). ROC curve analysis showed that serum IGFBP-7 and SIRT4 had a certain predictive value for prognosis in AHF patients, with AUC of 0.794 and 0.795, and the combined detection of IGFBP-7 and SIRT4 had a higher predictive value (AUC was 0.909, 95%CI, 0.858 to 0.959).
    Conclusion Serum IGFBP-7 and SIRT4 are highly expressed in patients with AHF, and their expression levels are correlated with clinical grade and prognosis, and the combined detection of the two indicators is of high reference value for evaluating the prognosis of patients.

     

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