FGF23与不同射血分数心力衰竭患者预后的相关性

    Prognostic value of fibroblast growth factor 23 in heart failure patients with different ejection fraction phenotype

      摘要
    • 摘要:
      目的 探究成纤维细胞生长因子23（FGF23）在不同射血分数（EF）心衰（HF）患者中的预后价值。
      方法 选取2019年～2020年于河北省人民医院心内科住院的HF患者208例，根据EF不同分为HFrEF组（n=72），HFmrEF组（n=58）和HFpEF组（n=78），中位随访时间3年。比较3组患者临床特征及FGF23的浓度水平，采用COX生存分析FGF23与不同射血分数HF患者预后的关系。
      结果 与HFpEF比较，HFmrEF组与HFrEF组收缩压（均P<0.01）降低，且HFrEF组低于HFmrEF组（P<0.01），HFrEF组吸烟史比例高（P<0.05）、HFmrEF组与HFrEF组饮酒史比例高（均P<0.05）、HFrEF组D二聚体升高（P<0.05）；HFpEF组与HFmrEF组NT-proBNP均低于HFrEF 组（均P<0.01）；与HFpEF比较，HFmrEF组与HFrEF组的LVEDD、LVESD升高、LVEF降低（均P<0.01），且LVEDD与LVESD数值HFrEF组高于HFmrEF组、LVEF数值HFrEF组低于HFmrEF组（均P<0.01）；出院后与HFpEF比较，HFmrEF组与HFrEF组的β受体阻滞剂比例高（均P<0.01）。HFrEF组ACEI/ARBy、利尿剂高于另外两组（均P<0.01），HFrEF组沙库巴曲缬沙坦比例高于HFpEF组（P<0.05）。FGF23浓度以及终点事件发生率在3组间差异无统计学意义。FGF23是HFpEF、HFmrEF和HFrEF患者发生心源性死亡和全因死亡的影响因素。较高浓度的FGF-23是HFpEF与HFmrEF患者发生全因死亡的危险因素，在对人口统计学、肾功能、心血管危险因素进行全面校正后，与低浓度组相比，高浓度FGF23的HFpEF患者全因死亡风险增加（HR 4.520，95%CI：1.379~14.810，P<0.05），而HFmrEF组FGF23与全因死亡的发生失去相关性。
      结论 高浓度FGF23是HFpHF发生全因死亡的独立危险因素。

       

      Abstract:
      AIM To investigate the prognostic value of fibroblast growth factor 23 (FGF23) in heart failure patients (HF) with different ejection fraction (EF).
      METHODS Two hundred and eight HF patients hospitalized in the Department of Cardiology in Hebei General hospital in 2019-2020 were selected and divided into the heart failure with reduced ejection fraction (HFrEF) group (n=72), heart failure with mid-range ejection fraction (HFmrEF) group (n=58) and heart failure with preserved ejection fraction (HFpEF) group (n=78) according to their EF, with a median follow-up of 3 years. Clinical characteristics and FGF23 levels were detected. COX survival analysis was used to analyze the relationship between FGF23 and prognosis.
      RESULTS Compared to HFpEF, The systolic blood pressure in the HFmrEF group and HFrEF group decreased (both P<0.01), and the HFrEF group was lower than the HFmrEF group (P<0.01), The proportion of smoking history was higher in the HFrEF group (P<0.05) The proportion of alcohol consumption history in the HFmrEF group and HFrEF group was higher (both P<0.05) The D-dimer in HFrEF group increased (P<0.05); The NT proBNP levels in both HFpEF and HFmrEF groups were lower than those in HFrEF group (both P<0.01); Compared to HFpEF, LVEDD of HFmrEF group and HFrEF group LVESD elevation LVEF decreased (both P<0.01), and LVEDD and LVESD values were higher in the HFrEF group than in the HFmrEF group LVEF values were lower in the HFrEF group than in the HFmrEF group (both P<0.01); Compared with HFpEF after discharge, The proportion of β - receptor blockers in the HFmrEF group and HFrEF group was high (both P<0.01). The ACEI/ARBy and diuretics in the HFrEF group were higher than those in the other two groups (both P<0.01), The proportion of sacubitril and valsartan in the HFrEF group was higher than that in the HFpEF group (P<0.05). There was no statistically significant difference in FGF23 concentration and endpoint event incidence among the three groups. FGF23 is HFpEF The influencing factors of cardiogenic and all-cause mortality in HFmrEF and HFrEF patients. Higher concentrations of FGF-23 are risk factors for all-cause mortality in HFpEF and HFmrEF patients. After comprehensive adjustment for demographic, renal function, and cardiovascular risk factors, HFpEF patients with high concentrations of FGF-23 have an increased risk of all-cause mortality compared to the low concentration group (HR 4.520, 95% CI: 1.379~14.810, P<0.05), However, there was no correlation between FGF23 and all-cause mortality in the HFmrEF group.
      CONCLUSION High levels of FGF23 are an independent risk factor for all-cause mortality in HFpHF.

       

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