目的 探讨血清总胆汁酸(total bile acid, TBA)及N末端B型钠尿肽原(N terminal pro B type natriuretic peptide, NT-proBNP)在慢性心力衰竭(chronic heart failure, CHF)合并2型糖尿病(type 2 diabetes,T2DM)患者预后评估中的应用价值。方法 选取2019-10至2020-06在北京电力医院住院CHF患者146例,根据是否合并T2DM,分为观察组(87例)及对照组(59例)。分别检测各组TBA及NT-proBNP水平,通过ROC曲线分析TBA、NT-proBNP及两者联合检测在CHF合并T2DM患者预后评估中的临床价值。结果 与对照组相比,TBA和NT-proBNP水平在观察组中均呈明显升高趋势(P<0.01)。Spearmen等级相关分析显示,观察组心功能分级与TBA水平呈正相关(rs=0.633,P<0.01);Pearson相关分析显示,观察组TBA水平与NT-proBNP水平呈正相关(r=0.539,P<0.01);ROC曲线分析显示血清TBA+NT-proBNP联合检测的ROC曲线下面积明显高于TBA和NT-proBNP(0.942 vs. 0.728和0.912,P<0.05)。结论 血清TBA水平在CHF合并T2DM患者中明显升高,且与心功能分级呈正相关;血清TBA、NT-proBNP水平对CHF合并T2DM患者的预后具有良好的预测价值,联合检测更优。
Abstract
Objective To study the applicability of serum total bile acid (TBA) and N terminal pro B type natriuretic peptide (NT-proBNP) in the assessment of prognosis of patients with chronic heart failure (CHF) complicated with type 2 diabetes (T2DM). Methods A total of 146 CHF patients hospitalized in Beijing Electric Power Hospital between October 2019 and June 2020 were selected and divided into the observation group (n=87) and control group (n=59) according to complications with T2DM. The levels of TBA and NT-proBNP in each group were detected, and the clinical value of TBA, NT-proBNP, and their combined detection in the prognosis assessment of CHF patients with T2DM was analyzed respectively by the ROC curve. Results Compared with the control group, the levels of TBA and NT-proBNP in the observation group were significantly increased (P<0.01). Spearmen grade correlation analysis showed that the cardiac function grade in the observation group was positively correlated with TBA levels (rs=0.633, P<0.01). Pearson correlation analysis showed that the level of TBA in the observation group was positively correlated with the level of NT-proBNP (r=0.539, P<0.01). ROC curve analysis showed that the area under the ROC curve with serum TBA+NT-proBNP combined detection was significantly larger than that of TBA and NT-proBNP used alone(0.942 vs. 0.728 and 0.912, P<0.05). Conclusions Serum TBA levels are significantly increased in CHF patients with T2DM and are positively correlated with cardiac function classification. Serum TBA and NT-proBNP levels can help predict the prognosis of CHF patients with T2DM, and combined detection is better.
关键词
总胆汁酸 /
N末端B型钠尿肽原 /
心力衰竭 /
糖尿病 /
ROC曲线
Key words
total bile acid /
NT-proBNP /
heart failure /
diabetes /
ROC curve
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 黎励文, 李明敏. 慢性心力衰竭的治疗进展[J]. 中华老年心脑血管病杂志, 2016,18(7):673-675.
[2] Braunwald E. Diabetes, heart failure, and renal dysfunction: the vicious circles [J]. Prog Cardiovasc Dis, 2019, 62(4): 298-302.
[3] 毛玉琳,何胜虎. 2型糖尿病和慢性心力衰竭[J]. 心血管病学进展, 2020,41(5):491-494.
[4] Rao A, Kosters A, Mells J E, et al. Inhibition of ileal bile acid uptake protects against nonalcoholic fatty liver disease in high-fat diet-fed mice [J]. Sci Transl Med, 2016, 8(357):122r-357r.
[5] McGlone E R, Bloom S R. Bile acids and the metabolic syndrome [J]. Ann Clin Biochem,2019,56(3):326-337.
[6] Shapiro H, Kolodziejczyk A A, Halstuch D, et al. Bile acids in glucose metabolism in health and disease [J]. J Exp Med, 2018, 215(2): 383-396.
[7] 徐辰祺,卜 军,何 奔.胆汁酸在心血管疾病中的作用[J].生理科学进展,2015,46(6):424-428.
[8] Mayerhofer C, Ueland T, Broch K, et al. Increased secondary/primary bile acid ratio in chronic heart failure[J]. J Card Fail, 2017, 23(9):666-671.
[9] Li W, Shu S, Cheng L, et al. Fasting serum total bile acid level is associated with coronary artery disease, myocardial infarction and severity of coronary lesions [J]. Atherosclerosis, 2020, 292:193-200.
[10] 中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志,2018,46 (10): 760-789.
[11] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中华糖尿病杂志,2018,10(1): 4-67.
[12] 陈 璐,秦明照. 糖尿病与慢性心力衰竭[J].中华老年心脑血管病杂志, 2018,20(10):1106-1109.
[13] Dauriz M, Mantovani A, Bonapace S, et al. Prognostic impact of diabetes on long-term survival outcomes in patients with heart failure: a meta-analysis[J]. Diabetes Care, 2017, 40(11):1597-1605.
[14] Chiang J, Ferrell J M. Bile acid metabolism in liver pathobiology[J]. Gene Exp, 2018, 18(2): 71-87.
[15] Chavez-Talavera O, Tailleux A, Lefebvre P, et al. Bile acid control of metabolism and inflammation in obesity, type 2 diabetes, dyslipidemia, and nonalcoholic fatty liver disease[J]. Gastroenterology, 2017,152(7):1679-1694.
[16] Zhu W, Wang S, Dai H, et al. Serum total bile acids associate with risk of incident type 2 diabetes and longitudinal changes in glucose-related metabolic traits [J]. J Diabetes, 2020,12(8): 616-625.
[17] Sun W, Zhang D, Wang Z, et al. Insulin resistance is associated with total bile acid level in type 2 diabetic and nondiabetic population: a cross-sectional study [J]. Medicine (Baltimore), 2016, 95(10):e2778.
[18] Sonne D P, van Nierop F S, Kulik W, et al. Postprandial plasma concentrations of individual bile acids and FGF-19 in patients with type 2 diabetes[J]. J Clin Endocrinol Metab, 2016, 101(8): 3002-3009.
[19] Li T, Chanda D, Zhang Y, et al. Glucose stimulates cholesterol 7alpha-hydroxylase gene transcription in human hepatocytes[J]. J Lipid Res,2010,51(4):832-842.
[20] Li T, Kong X, Owsley E, et al. Insulin regulation of cholesterol 7alpha-hydroxylase expression in human hepatocytes: roles of forkhead box O1 and sterol regulatory element-binding protein 1c [J]. J Biol Chem, 2006, 281(39): 28745-28754.
[21] 单 瑞, 杨培根. 老年慢性心衰患者血清胆汁酸水平与炎症因子及心室重构的关系[J]. 天津医药, 2018,46(1):42-45.
[22] 张 蕾,李 跃,何立娟, 等. 慢性心力衰竭患者血清TBA水平与心室重构及炎症反应的相关性[J]. 中国循证心血管医学杂志, 2018, 12:1506-1509.
[23] 徐 亮,杨 松,王 稳,等. NT-proBNP对慢性心力衰竭患者心功能的评估价值[J]. 临床和实验医学杂志, 2018, 17(24):2626-2629.
PDF(729 KB)
