2021 年第 12 期 第 16 卷

糖尿病心肌病患者血清成纤维细胞生长因子21水平变化及与左心功能的相关性

Changes of serum fibroblast growth factor 21 level and its correlation with left cardiac function in patients with diabetic cardiomyopathy

作者：于倩1矫妮2侯培培1张京京1

英文作者：Yu Qian1 Jiao Ni2 Hou Peipei1 Zhang Jingjing1

单位：1辽宁省人民医院心血管内科，沈阳110016；2辽宁省人民医院心功能科，沈阳110016

英文单位：1Department of Cardiovascular Medicine the People′s Hospital of Liaoning Province Shenyang 110016 China； 2Department of Cardiac Function the People′s Hospital of Liaoning Province Shenyang 110016 China

关键词：糖尿病心肌病；成纤维细胞生长因子21；左心功能；2型糖尿病

英文关键词：Diabeticcardiomyopathy;Fibroblastgrowthfactor21;Leftcardiacfunction;Type2diabetesmellitus

• 摘要：

• 目的 探讨糖尿病心肌病（DCM）患者血清成纤维细胞生长因子21（FGF21）水平变化以及与左心功能的相关性。方法 回顾性分析辽宁省人民医院2019年7月至2020年10月收治的106例2型糖尿病患者临床资料，其中DCM患者53例（观察组），左心室二维结构正常者53例（对照组）。比较2组患者一般资料、各实验室检测指标和左心功能指标水平，分析血清FGF21水平对2型糖尿病患者DCM发病风险的影响、对DCM的诊断价值以及DCM组血清FGF21与左心功能指标的相关性。结果  观察组糖尿病病程长于对照组［8（6，11）年比5（3，8）年］，血清B型脑钠肽、肌红蛋白、总胆固醇、低密度脂蛋白胆固醇和FGF21水平均高于对照组［(6.3±2.0)ng/L比（4.4±1.4）ng/L，17.9（12.8，27.1）μg/L比15.4（8.2，21.6）μg/L，(4.2±1.6)mmol/L比（3.3±0.9）mmol/L，(2.9±1.1)mmol/L比（2.3±0.7）mmol/L，218.4（160.6，317.9）ng/L比170.5（133.9，218.4）ng/L］（均P<0.05）。经多元Logistic回归分析，无论是否校正混杂因素，血清FGF21>187.6 ng/L均使2型糖尿病患者发生DCM的风险增加（均P<0.05）。血清FGF21用于诊断DCM的曲线下面积为0.712（95%置信区间：0.611~0.813），最佳界值为232.89 ng/L，敏感度和特异度分别为47.3%和85.9%。观察组二尖瓣早期血流速度峰值（E）、左侧壁二尖瓣环早期峰值速度均值（e′）、二尖瓣早/晚期血流速度峰值（E/A）比值和左心室射血分数（LVEF）均低于对照组，E/e′比值和Tei指数均高于对照组（均P<0.05）。观察组血清FGF21水平与E、E/A、e′和LVEF均呈负相关（r=-0.368、-0.411、-0.294、-0.571，均P<0.05），与Tei指数呈正相关（r=0.510，P<0.05）。结论  DCM患者血清FGF21水平显著升高，左心功能损害程度更重。2型糖尿病患者血清FGF21>187.6 ng/L时发生DCM的风险升高，检测血清FGF21水平有助于DCM的早期诊断。

• Objective To investigate the changes of serum fibroblast growth factor 21 (FGF21) level and its correlation with left cardiac function in patients with diabetic cardiomyopathy (DCM). Methods From July 2019 to October 2020, the clinical data of 106 patients with type 2 diabetes mellitus admitted to the People′s Hospital of Liaoning Province were retrospectively analyzed. There were 53 cases with DCM (observation group) and 53 cases with normal two-dimensional structure of left ventricle (control group). The general data, laboratory indexes and left ventricular function indexes of the two groups were compared. The influence of serum FGF21 level on the risk of DCM in type 2 diabetes mellitus, the diagnostic value of DCM and the correlation between serum FGF21 and left cardiac function in DCM group were analyzed. Results The duration of diabetes mellitus in the observation group was longer than that in the control group ［8(6,11)years vs 5(3,8)years］, and the serum levels of brain natriuretic peptide, myoglobin, total cholesterol, low-density lipoprotein cholesterol and FGF21 in the observation group were higher than those in the control group ［(6.3±2.0)ng/L vs （4.4±1.4）ng/L，17.9（12.8，27.1）μg/L vs 15.4（8.2，21.6）μg/L，(4.2±1.6)mmol/L vs （3.3±0.9）mmol/L，(2.9±1.1)mmol/L vs （2.3±0.7）mmol/L，218.4（160.6，317.9）ng/L vs 170.5（133.9，218.4）ng/L］（all P<0.05）. Multivariate Logistic regression analysis showed that FGF21>187.6 ng/L was an independent risk factor for DCM in patients with type 2 diabetes mellitus, regardless of whether or not the confounding factors were corrected（both P<0.05）. The area under the curve of serum FGF21 in the diagnosis of DCM was 0.712 (95% confidence interval: 0.611-0.813), the cut-off value was 232.89 ng/L, the sensitivity and specificity were 47.3% and 85.9%, respectively. The early peak velocity of mitral valve (E), mean value of early peak velocity of left mitral annulus (e ′), early/late peak velocity ratio of mitral valve (E/A) and left ventricular ejection fraction (LVEF) in the observation group were lower than those in the control group, while E/e′ and Tei index in the observation group were higher than those in the control group (all P<0.05). In the observation group, serum FGF21 level was negatively correlated with E, E/A, e′and LVEF (r=-0.368, -0.411, -0.294, -0.571, all P<0.05), and positively correlated with Tei index (r=0.510, P<0.05). Conclusions   The serum FGF21 level of DCM patients increases significantly, and the degree of left cardiac function damage is more serious. The risk of DCM increases with serum FGF21 >187.6 ng/L in patients with type 2 diabetes mellitus. Detection of serum FGF21 level is helpful for early diagnosis of DCM.