Gan Feng, Huang Jiafang, Dai Tianran, Li Maorong, Liu Jinghua
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing 100029, China; Department of Cardiology, Beijing Aerospace General Hospital, Beijing 100076, China.
Laboratory Department, Beijing Aerospace General Hospital, Beijing 100076, China.
Ann Palliat Med. 2020 Mar;9(2):368-374. doi: 10.21037/apm.2020.03.28.
This study aimed to investigate the relationship between serum level of fibroblast growth factor 21 (FGF-21) and long-term prognosis in patients with both diabetes mellitus (DM) and coronary artery calcification (CAC).
The study included 1,132 patients with DM and CAC according to inclusion and exclusion criteria. Based on the baseline serum level of FGF-21, patients were divided into four groups (283 in each group): low-FGF-21 group (LFG), lower-medium-FGF-21 group (LMFG), higher-medium-FGF-21 group (HMFG), and high-FGF-21 group (HFG). Major adverse cardiovascular events (MACEs), including coronary revascularization, acute coronary syndrome (ACS), heart failure (HF), malignant arrhythmia, and sudden cardiac death (SCD), were recorded. Renal function, serum level of NT-proBNP, and left ventricular function were watched and observed during follow-up.
All patients were followed up for 1.5-5.1 (2.7±2.2) years. The range of baseline serum level of FGF-21 was 67.5-314.7 pg/mL. The serum level of FGF-21 was ≤103.8 pg/mL in LFG, 108.6-184.9 pg/mL in LMFG, 199.3-271.2 pg/mL in LHFG, and >276.1 pg/mL in HFG. The baseline CAC score (CACS) was 83.2-524.9 and the mean CACS was 124.6±37.5, 186.8±51.9, 271.3±62.7, and 349.2±80.6, respectively. During follow-up, 481 patients underwent percutaneous coronary intervention (PCI) with 71, 107, 141, and 162 in subgroups, respectively. Malignant arrhythmia occurred in 89 patients, HF in 127, and SCD in 9. At the end of the 1-year follow-up, the average eGFR, NT-proBNP, and left ventricular ejection fraction (LVEF) differed significantly among groups.
Lower baseline serum level of FGF-21 is a prediction for a better long-term prognosis.
本研究旨在探讨糖尿病（DM）合并冠状动脉钙化（CAC）患者血清成纤维细胞生长因子21（FGF-21）水平与长期预后的关系。
根据纳入和排除标准，本研究纳入了1132例DM合并CAC患者。根据FGF-21的基线血清水平，将患者分为四组（每组283例）：低FGF-21组（LFG）、中低FGF-21组（LMFG）、中高FGF-21组（HMFG）和高FGF-21组（HFG）。记录主要不良心血管事件（MACE），包括冠状动脉血运重建、急性冠状动脉综合征（ACS）、心力衰竭（HF）、恶性心律失常和心源性猝死（SCD）。随访期间观察肾功能、NT-proBNP血清水平和左心室功能。
所有患者随访1.5 - 5.1（2.7±2.2）年。FGF-21基线血清水平范围为67.5 - 314.7 pg/mL。LFG组FGF-21血清水平≤103.8 pg/mL，LMFG组为108.6 - 184.9 pg/mL，LHFG组为199.3 - 271.2 pg/mL，HFG组>276.1 pg/mL。基线冠状动脉钙化评分（CACS）为83.2 - 524.9，平均CACS分别为124.6±37.5、186.8±51.9、271.3±62.7和349.2±80.6。随访期间，481例患者接受了经皮冠状动脉介入治疗（PCI），各亚组分别为71例、107例、141例和162例。89例患者发生恶性心律失常，127例发生HF，9例发生SCD。在1年随访结束时，各组的平均估算肾小球滤过率（eGFR）、NT-proBNP和左心室射血分数（LVEF）差异显著。
较低的FGF-21基线血清水平预示着较好的长期预后。
