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目的:分析半乳糖凝集素3(Gal-3)及成纤维细胞生长因子23(FGF-23)与慢性肾脏病(CKD)患者心血管危险因素和心血管重塑的相关关系,评价与传统标记物组合预测心血管风险的价值。方法:分析CKD患者临床信息,完善常规实验室检查,检测N-末端脑钠肽前体(NT-pro BNP)、肌钙蛋白T(Tn T)、Gal-3和FGF-23浓度。心脏超声测定相对室壁厚度和左心室质量指数,将心脏塑形分为结构正常与左心室塑形改变(包括左心室重塑、向心性肥厚与离心性肥厚)。以左心室塑形改变为标准,比较NT-pro BNP与Gal-3和FGF-23不同组合的ROC曲线下面积(AUC)。结果:共纳入CKD患者270例(2期57例、3期74例、4期68例、5期71例)。Gal-3和FGF-23水平均与患者多重心血管危险因素相关,包括收缩压、血红蛋白、血清白蛋白、磷、甲状旁腺激素、NT-pro BNP、Tn T、e GFR水平及是否合并糖尿病(P<0.05)。伴随Gal-3和FGF-23水平升高,患者左心室塑形改变显著(P<0.05)。与NT-pro BNP相比,Gal-3和FGF-23各单项指标判断左心室塑形改变的AUC差异均无统计学意义(P>0.05);NT-pro BNP与Gal-3组合或三者组合可轻度提高AUC(P>0.05)。结论:Gal-3与FGF-23水平不仅与CKD患者多重心血管危险因素相关,且反映左心室塑形改变;两者与NT-pro BNP组合可提高判断心血管风险的价值。
Objective: To analyze the relationship between cardiovascular risk factors and cardiovascular remodeling of Gal-3, fibroblast growth factor 23 (FGF-23) and chronic kidney disease (CKD) The value of a combination of predictors of cardiovascular risk. Methods: The clinical information of patients with CKD was analyzed and routine laboratory tests were performed. The concentrations of NT-proBNP, TnT, Gal-3 and FGF-23 were detected. Cardiac echocardiography was used to determine the relative wall thickness and left ventricular mass index. The heart shape was divided into normal structure and left ventricular shape changes (including left ventricular remodeling, concentric hypertrophy and eccentric hypertrophy). The area under the ROC curve (AUC) for different combinations of NT-pro BNP with Gal-3 and FGF-23 was compared with the left ventricular shape change as the standard. Results: A total of 270 CKD patients were included (57 in stage 2, 74 in stage 3, 68 in stage 4 and 71 in stage 5). The levels of Gal-3 and FGF-23 were associated with multiple cardiovascular risk factors including systolic blood pressure, hemoglobin, serum albumin, phosphorus, parathyroid hormone, NT-pro BNP, Tn T, e GFR and with or without diabetes mellitus (P <0.05). With the increase of the levels of Gal-3 and FGF-23, the left ventricular shape changes significantly (P <0.05). Compared with NT-pro BNP, the AUC of Gal-3 and FGF-23 in each index showed no significant difference (P> 0.05); NT-pro BNP combined with Gal-3 or three Combination can be slightly increased AUC (P> 0.05). CONCLUSIONS: The levels of Gal-3 and FGF-23 are not only correlated with multiple cardiovascular risk factors in patients with CKD, but also reflect the changes of left ventricular shape. The combination of NT-pro BNP and NT-pro BNP can improve the value of determining cardiovascular risk.