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FIB-4肝脏生物标志物评分与心力衰竭严重程度的相关性。

Correlation of the FIB-4 Liver Biomarker Score with the Severity of Heart Failure.

作者信息

Buzas Roxana, Ciubotaru Paul, Faur Alexandra Corina, Preda Marius, Ardelean Melania, Georgescu Doina, Dumitrescu Patrick, Lighezan Daniel Florin, Popa Mihaela-Diana

机构信息

1st Medical Semiology, Internal Medicine, Department V, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.

Center for Advanced Research in Cardiovascular Pathology and in Hemostaseology, 300041 Timisoara, Romania.

出版信息

Medicina (Kaunas). 2024 Nov 26;60(12):1943. doi: 10.3390/medicina60121943.

Abstract

: Heart failure is associated with high morbidity and mortality and linked with several pre-existing health conditions and risk factors. Early detection and prompt management in heart failure improves patient outcomes. Liver involvement is associated with heart failure disease progression, and hence liver biomarkers and liver fibrosis may have a prognostic impact. Several blood test based markers and scoring systems estimate liver fibrosis and hence can be useful prognostic tools. : We retrospectively analyzed a series of 303 patients with decompensated heart failure in a city in western Romania over a period of 6 months. Several biochemical parameters were measured, the FIB-4 score was estimated and echocardiography was performed. Results for targeted variables are presented using descriptive statistics. Patients were analyzed based on their LVEF categories. Statistical analysis was based on ANOVA one-way tests for continuous variables and Chi-square tests for categorical variables. Pairwise comparisons were performed based on Bonferroni adjusted significance tests. The correlations between FIB-4 score, LVEF and NT-pro BNP in patients with and without diabetes and hypertension were explored using Spearman's correlation coefficient. : Age, gender, NYHA class, death, history of (h/o) type 2 diabetes mellitus (T2DM), h/o coronary artery disease (CAD), h/o arrhythmias, sodium, potassium, creatinine, eGFR, uric acid, NT-pro BNP, left atrial volume, LDL, HDL, and TG were analyzed by LVEF categories using ANOVA one-way tests, Chi-square tests, and Bonferroni correction comparisons. We found a strong statistically significant correlation between each of NT-pro BNP, left atrial volume, LDL, and HDL with the LVEF categories. : Early detection of cardiac dysfunction leads to better management in patients with cardiovascular risk factors including diabetes and hypertension. High LDL and low HDL levels contribute to a reduction in left ventricular (LV) function. Available literature suggests the FIB-4 score as superior to other non-invasive markers of fibrosis. It utilizes the patient's age, platelet count, AST, and ALT, which can be available retrospectively, making it an easy and inexpensive tool. FIB-4 score has a few limitations. : Our study has shown a statistically significant positive correlation between severity categories of LVEF and FIB-4 score for heart failure patients with and without diabetes, and for heart failure patients with or without hypertension. We propose the implementation of FIB-4 score as a prognostic tool for heart failure.

摘要

心力衰竭与高发病率和死亡率相关,并与多种已存在的健康状况和风险因素有关。心力衰竭的早期检测和及时管理可改善患者预后。肝脏受累与心力衰竭疾病进展相关,因此肝脏生物标志物和肝纤维化可能具有预后影响。几种基于血液检测的标志物和评分系统可评估肝纤维化,因此可作为有用的预后工具。

我们回顾性分析了罗马尼亚西部一个城市6个月内的303例失代偿性心力衰竭患者。测量了多种生化参数,估算了FIB-4评分,并进行了超声心动图检查。使用描述性统计呈现目标变量的结果。根据患者的左心室射血分数(LVEF)类别对患者进行分析。统计分析基于连续变量的单因素方差分析(ANOVA)和分类变量的卡方检验。基于Bonferroni校正的显著性检验进行两两比较。使用Spearman相关系数探讨了有和没有糖尿病及高血压的患者中FIB-4评分、LVEF和N末端B型利钠肽原(NT-pro BNP)之间的相关性。

通过单因素方差分析、卡方检验和Bonferroni校正比较,按LVEF类别分析了年龄、性别、纽约心脏协会(NYHA)分级、死亡情况、2型糖尿病(T2DM)病史、冠状动脉疾病(CAD)病史、心律失常病史、钠、钾、肌酐、估算肾小球滤过率(eGFR)、尿酸、NT-pro BNP、左心房容积、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)和甘油三酯(TG)。我们发现NT-pro BNP、左心房容积、LDL和HDL中的每一项与LVEF类别之间均存在高度统计学显著相关性。

早期发现心脏功能障碍可使包括糖尿病和高血压在内的心血管危险因素患者得到更好的管理。高LDL和低HDL水平会导致左心室(LV)功能降低。现有文献表明FIB-4评分优于其他纤维化非侵入性标志物。它利用患者的年龄、血小板计数、谷草转氨酶(AST)和谷丙转氨酶(ALT),这些信息可通过回顾获得,使其成为一种简便且廉价的工具。FIB-4评分有一些局限性。

我们的研究表明,对于有和没有糖尿病的心力衰竭患者以及有和没有高血压的心力衰竭患者,LVEF严重程度类别与FIB-4评分之间存在统计学显著正相关。我们建议将FIB-4评分作为心力衰竭的一种预后工具。

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