| IGF1R对2型糖尿病患者射血分数保留型心力衰竭的诊断及预后价值评估 |
| 投稿时间：2025-03-17 修订日期：2025-04-14 点此下载全文 |
| 引用本文：韦银霞,赖晴霞,李文鹏,戴迎春,苏梦琦.IGF1R对2型糖尿病患者射血分数保留型心力衰竭的诊断及预后价值评估[J].医学研究杂志,2025,54(9):56-61 |
| DOI：
10.11969/j.issn.1673-548X.2025.09.011 |
| 摘要点击次数: 42 |
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| 基金项目:国家自然科学基金资助项目(82300457)；广东省基础与应用基础研究基金项目(2022A1515110881)；深圳市科技计划项目(JCYJ20220530142410023)；深圳市优秀科技创新人才培养项目(RCBS20221008093335085) |
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| 中文摘要:目的 探究胰岛素样生长因子1受体(insulin growth factor 1 receptor, IGF1R)作为2型糖尿病(type 2diabetes mellitus, T2DM)患者射血分数保留型心力衰竭(heart failure with preserved ejection fraction, HFpEF)进展的生物学标志物的诊断及预后价值。方法 选取2019年6月~2023年3月在香港大学深圳医院接受治疗的383例T2DM患者作为研究对象,根据HFpEF的诊断标准分为非HFpEF组(n=190)和HFpEF组(n=193)。收集资料,采用酶联免疫吸附试验(enzyme-linked immunosorbent assa, ELISA)法检测血清IGF1R水平；采用配对样本t检验、非参数检验或χ2检验比较临床资料和超声心动图结果；受试者工作特征(receiver operating characteristic, ROC)曲线分析IGF1R水平对HFpEF的诊断价值；非参数检验比较基线和随访的超声心动图检查；Kaplan-Meier曲线评估IGF1R水平对再住院的影响。结果 以是否合并HFpEF分组显示,HFpEF组年龄更大、心房颤动患者比例更高、糖尿病病程更长(P＜0.05),血糖、肌酐、N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide, NT-proBNP)、IGF1R水平显著升高(P＜0.05),超声心动图显示心脏收缩和舒张功能显著下降(P＜0.05)。以IGF1R水平分组与按是否合并HFpEF分组得到相似结果。ROC曲线分析结果显示,IGF1R诊断T2DM患者发生HFpEF的曲线下面积(area under the curve, AUC)为0.79。根据IGF1R水平对非HFpEF和HFpEF组人群进行亚组分析,结果显示,非HFpEF组和HFpEF组的高IGF1R患者的心脏收缩和舒张功能均更差(P＜0.05)。随访发现,高IGF1R组的心脏收缩和舒张功能较基线显著下降(P＜0.05)。Kaplan-Meier曲线分析结果显示,高IGF1R患者因心血管事件再住院的风险显著增加(P=0.007)。结论 IGF1R可作为T2DM患者监测心脏结构功能损伤、诊断HFpEF发生风险、预测远期心脏结构和功能恶化的生物学标志物。 |
| 中文关键词:胰岛素样生长因子1受体 2型糖尿病 射血分数保留型心力衰竭 诊断价值 |
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| Evaluation of the Diagnostic and Prognostic Value of IGF1R in Patients with Type 2 Diabetes Mellitus and Heart Failure with Preserved Ejection Fraction |
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| Abstract:Objective To explore the diagnostic and prognostic value of insulin growth factor 1 receptor (IGF1R) as a biomarker for the progression of heart failure with preserved ejection fraction (HFpEF) in patients with type 2diabetes mellitus (T2DM). Methods A total of 383 patients with type 2diabetes who received treatment in the hospital from June 2019 to March 2023 were selected as the study objects, and they were divided into non-HFPEF group (n=190) and HFpEF group (n=193) according to diagnostic criteria of HFpEF. The clinical data of the patients were collected, and the IGF1R level was determined by enzyme-linked immunosorbent assay (ELISA). Paired sample t-test, nonparametric test or χ2 test were used to compare clinical data and echocardiographic results. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of IGF1R in HFpEF. Nonparametric test was used to compared baseline and post-follow-up echocardiography; Kaplan-Meier curves were used to assess the effects of IGF1R levels on readmission. Results Analysis by whether to merge HFpEF groups showed that, in HFpEF group, the patients were older, the proportion of atrial fibrillation patients was higher, the duration of diabetes was longer (P<0.05), the levels of blood glucose, creatinine, N-terminal pro-brain natriuretic peptide (NT-proBNP) and IGF1R were significantly increased (P<0.05), and echocardiography also showed that the systolic and diastolic function of the heart was significantly decreased (P<0.05). Similar results were obtained by IGF1R horizontal grouping. The ROC curve showed that the area under the curve (AUC) of IGF1R for predicting HFpEF in T2DM patients was 0.79. Subgroup analysis of non-HFPEF and HFpEF groups based on IGF1R levels showed that patients with high IGF1R in both the non-HFPEF and HFpEF groups had worse systolic and diastolic function (P<0.05). Follow-up revealed that the systolic and diastolic function in the high IGF1R group decreased significantly from baseline (P<0.05). Kaplan-Meier curve analysis showed a significantly increased risk of re-hospitalization due to cardiovascular events in the high IGF1R group (P=0.007). Conclusion IGF1R can be used as a biomarker to monitor structural and functional damage of heart, diagnosing the risk of HFpEF, and predicting the long-term deterioration of cardiac structure and function in T2DM patients. |
| keywords:Insulin growth factor 1 receptor Type 2diabetes mellitus Heart failure with preserved ejection fraction Diagnostic value |
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