成纤维细胞生长因子-23和慢性心力衰竭的相关性研究

目的 通过慢性心力衰竭与成纤维细胞生长因子（FGF）-23水平的相关性研究,探索心力衰竭的发病机制,为慢性心力衰竭诊断提供新的方法.方法 选择128例慢性心力衰竭患者（慢性心力衰竭组）,按左室射血分数（LVEF）水平分为LVEF轻度减低组（LVEF 40％～50％,50例）、LVEF中度减低组（LVEF30％ ～ 39％,35例）、LVEF重度减低组（LVEF＜ 30％,43例）.另选择同期健康体检者50例作为对照组.检测各组FGF-23、甲状旁腺激素（PTH）及肌酐（Cr）、尿素氮（BUN）、血钙、血磷、N末端B型钠尿肽前体（NT-proBNP）水平,并进行心脏彩色超声检查.结果 慢性心力衰竭组FGF-23、血磷、PTH、左室质量指数（LV MI）、NT-proBNP显著高于对照组68.44（55.85～ 94.73）ngL比34.18 （30.57～38.87） ng/L、（1.13±0.13） mmol/L比（1.02±0.12） mmol/L、（15.51±3.99） ng/L比（9.97±0.89） ng/L、（112.27±52.02） g/m2比（71.37±12.95） g/m2、（6 265.3±15 991.6） ng/L比（76.12±51.80） ng/L],血钙、GFR低于对照组（2.28±0.16） mmol/L比（2.48±0.13） mmol/L、（78.28±14.20） ml/（min· 1.73 m2）比（85.03±14.44） ml/（min·1.73 m2）],差异均有统计学意义（P＜0.01）.Spearman相关分析显示,FGF-23与年龄（r=0.256,P＜0.01）、血磷（r=0.326,P＜0.01）、PTH （r=0.584,P＜0.01）、NT-proBNP（r=0.799,P＜0.01）、LVMI（r=0.540,P＜ 0.01）呈正相关,与血钙（r=-0.308,P＜0.01）、GFR（r=-0.527,P＜0.01）呈负相关.FGF-23水平随着LVEF水平的降低而升高.结论 FGF-23水平与慢性心力衰竭严重程度密切相关,提示其可作为评价心肌收缩功能标志物之一.

The correlation study of fibroblast growth factor 23 and chronic heart failure

Objective Through the correlation study of fibroblast growth factor 23 （FGF-23） and chronic heart failure to investigate the pathogenesis of chronic heart failure and provide a new method for chronic heart failure diagnosis.Methods One hundred and twenty-eight chronic heart failure patients （chronic heart failure group） were involved in this study.According to the level of left ventricular ejection fraction （LVEF）,they were divided into LVEF slightly lowing group （LVEF 40%-50%,50 patients）,LVEF moderately lowing group （LVEF 30%-39%,35 patients）,LVEF severely lowing group （LVEF 〈30%,43 patients）.Fifty healthy people was as control group.The level of FGF-23,parathyroid hormone （PTH）,creatinine （Cr）,urea nitrogen （BUN）,blood calcium,blood phosphorus,N-terminal pro-B-type natriuretic peptide （NT-proBNP） were detected.The patients in two groups were performed color Doppler ultrasonography.Results The level of FGF-23,blood phosphorus,PTH,left ventricular mass index （LVMI）,NT-proBNP in chronic heart failure group were significantly higher than those in control group 68.44（55.85-94.73） ng/L,34.18（30.57-38.87） ng/L,（1.13 ± 0.13） mmol/L vs.（1.02± 0.12） mmol/L,（15.51 ± 3.99） ng/L vs.（9.97 ± 0.89） ng/L,（112.27 ± 52.02） g/m2 vs.（71.37 ± 12.95） g/m2,（6 265.3 ± 15 991.6） ng/L vs.（76.12 ± 51.80） ng/L]（P 〈 0.01）.The level of blood calcium,glomerular filtration rate （GFR） in chronic heart failure group were significantly lower than those in control group （2.28 ±0.16） mmol/L vs.（2.48 ±0.13） mmol/L,（78.28 ± 14.20） ml/ （min ·1.73 m2） vs.（85.03 ± 14.44）ml/ （min·1.73 m2）] （P 〈 0.01）.Spearman correlation analysis showed that FGF-23 had positive correlation with age （r =0.256,P 〈0.01）,blood phosphorus （r =0.326,P 〈0.01）,PTH （r =0.584,P 〈0.01）,NT-proBNP （r =0.799,P 〈 0.01）,LVMI （r =0.540,P 〈 0.01）,and had negative correlation with blood calcium （r =-0.308,P 〈 0.01）,GFR（r =-0.527,P 〈 0.01）.The level of FGF-23 was increased when LVEF reduced.Conclusions It has significant correlation between the level of FGF-23 and the degree of chronic heart failure.It suggests that the level of FGF-23 can evaluate the myocardial systolic function and ventricular remodeling.