内脂素可独立于利钠肽水平预测2型糖尿病患者的无症状性心力衰竭。

Adropin Predicts Asymptomatic Heart Failure in Patients with Type 2 Diabetes Mellitus Independent of the Levels of Natriuretic Peptides.

作者信息

Berezina Tetiana A, Berezin Oleksandr O, Hoppe Uta C, Lichtenauer Michael, Berezin Alexander E

机构信息

Department of Internal Medicine and Nephrology, VitaCenter, 69000 Zaporozhye, Ukraine.

Luzerner Psychiatrie AG, 4915 St. Urban, Switzerland.

出版信息

Diagnostics (Basel). 2024 Aug 9;14(16):1728. doi: 10.3390/diagnostics14161728.

Abstract

In patients with type 2 diabetes mellitus (T2DM), asymptomatic adverse cardiac remodeling plays a pivotal role in the development of heart failure (HF). Patients with T2DM often have low or near-normal levels of natriuretic peptides, including N-terminal brain natriuretic peptide (NT-proBNP), which have been inconclusive in predicting the transition from asymptomatic adverse cardiac remodeling to HF with preserved ejection fraction (HFpEF). The aim of this study was to elucidate the predictive ability of adropin for HFpEF depending on the circulating levels of NT-proBNP. We prospectively enrolled 561 T2DM patients (glycated hemoglobin < 6.9%) with echocardiographic evidence of structural cardiac abnormalities and left ventricular ejection fractions >50%. All patients underwent B-mode transthoracic echocardiographic and Doppler examinations. Circulating biomarkers, i.e., NT-proBNP and adropin, were assessed at baseline. All individuals were divided into two groups according to the presence of low levels (<125 pmol/mL; = 162) or elevated levels (≥125 pmol/mL; = 399) of NT-proBNP. Patients with known asymptomatic adverse cardiac remodeling and elevated NT-proBNP were classified as having asymptomatic HFpEF. A multivariate logistic regression showed that low serum levels of adropin (<3.5 ng/mL), its combination with any level of NT-proBNP, and use of SGLT2 inhibitors were independent predictors of HFpEF. However, low levels of adropin significantly increased the predictive ability of NT-proBNP for asymptomatic HFpEF in patients with T2DM, even though the concentrations of NT-proBNP were low, while adropin added discriminatory value to all concentrations of NT-proBNP. In conclusion, low levels of adropin significantly increase the predictive ability of NT-proBNP for asymptomatic HFpEF in patients with T2DM.

摘要

在2型糖尿病(T2DM)患者中,无症状性不良心脏重塑在心力衰竭(HF)的发生发展中起关键作用。T2DM患者的利钠肽水平通常较低或接近正常,包括N末端脑利钠肽前体(NT-proBNP),其在预测从无症状性不良心脏重塑向射血分数保留的心力衰竭(HFpEF)转变方面尚无定论。本研究的目的是根据NT-proBNP的循环水平阐明阿朴脂蛋白对HFpEF的预测能力。我们前瞻性纳入了561例T2DM患者(糖化血红蛋白<6.9%),这些患者有心脏结构异常的超声心动图证据且左心室射血分数>50%。所有患者均接受了B型经胸超声心动图和多普勒检查。在基线时评估循环生物标志物,即NT-proBNP和阿朴脂蛋白。根据NT-proBNP水平低(<125 pmol/mL;n = 162)或高(≥125 pmol/mL;n = 399)将所有个体分为两组。已知有无症状性不良心脏重塑且NT-proBNP升高的患者被归类为无症状HFpEF。多因素逻辑回归显示,血清阿朴脂蛋白水平低(<3.5 ng/mL)、其与任何水平的NT-proBNP联合以及使用钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂是HFpEF的独立预测因素。然而,即使NT-proBNP浓度较低,阿朴脂蛋白水平低也显著提高了NT-proBNP对T2DM患者无症状HFpEF的预测能力,而阿朴脂蛋白为所有浓度的NT-proBNP增加了鉴别价值。总之,阿朴脂蛋白水平低显著提高了NT-proBNP对T2DM患者无症状HFpEF的预测能力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f9cc/11353117/fbd61ebbd419/diagnostics-14-01728-g001.jpg

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