摘要： 目的 探讨血浆胰岛素样生长因子结合蛋白-7 （IGFBP7）以及IGFBP7联合N末端B型利钠肽原（NT-proBNP）在急性心力衰竭所致呼吸困难中的诊断价值。方法 选取2018年3月至2020年9月中国医科大学附属第一医院急诊科就诊的154例急性呼吸困难患者为研究对象，根据临床诊断结果，将患者分为非急性心力衰竭组（n=93）和急性心力衰竭组（n=61）。2组患者均进行血常规，肝、肾功能，胸部X线片、心电图和超声心动图检查及左心室射血分数（LVEF）、血浆IGFBP7和NT-proBNP水平检测。采用t检验或χ²检验比较2组各项临床指标的差异，对有统计学意义（P < 0.05）指标采用logistic回归分析急性心力衰竭的危险因素。采用受试者操作特征（ROC）曲线分析IGFBP7、NT-proBNP以及二者联合对急性心力衰竭患者呼吸困难的诊断价值。结果 与非急性心力衰竭组比较，急性心力衰竭组患者合并高血压、冠状动脉疾病、心房颤动比例，血浆IGFBP7和NT-proBNP水平显著增高，而合并哮喘/慢性阻塞性肺疾病（COPD）比例、LVEF和肾小球滤过率估算值（eGFR）则显著降低（均P < 0.05）。logistic回归分析结果显示，IGFBP7、NT-proBNP升高及LVEF降低是急性心力衰竭的危险因素（均P < 0.05）。ROC曲线分析表明，IGFBP7的ROC曲线曲线下面积（AUC）为0.878 （0.821~0.935）。IGFBP7最佳截断值为98.4 ng/mL，诊断心力衰竭性呼吸困难的灵敏度为85.2%，特异度为82.8%。NT-proBNP的ROC曲线AUC为0.879 （0.818~0.940）。NT-proBNP的最佳截断值为1 366 ng/L，诊断心力衰竭性呼吸困难的灵敏度为85.2%，特异度为89.2%。二者联合诊断的AUC为0.952 （0.918~0.986），灵敏度为88.5%，特异度92.5%。结论 单独使用IGFBP7或联合NT-proBNP是诊断急性心力衰竭所致呼吸困难的有效方法，IGFBP7可作为一种新型的急性心力衰竭的生物学标志物。

胰岛素样生长因子结合蛋白-7在急性心力衰竭所致呼吸困难诊断中的应用

赵楠¹, 薛晖¹, 苏晗², 吴伟³

1. 中国医科大学附属第一医院妇科, 沈阳 110001;
2. 中国医科大学附属盛京医院设备科, 沈阳 110004;
3. 中国医科大学附属第一医院急诊科, 沈阳 110001

收稿日期:2022-07-04出版日期:2023-02-28发布日期:2023-02-04
通讯作者:薛晖E-mail:cmuxuehui@163.com
作者简介:赵楠(1984-),女,技师,本科.
基金资助:辽宁省教育厅科学研究项目（QN2019011）


关键词: 急性心力衰竭, 呼吸困难, 胰岛素样生长因子结合蛋白-7, N末端脑钠肽前体, 诊断
Abstract: Objective To investigate the diagnostic value of plasma insulin-like growth factor binding protein-7 (IGFBP7) and IGFBP7 combined with N-terminal pro-B type natriuretic peptide (NT-proBNP) in dyspnea caused by acute heart failure (HF). Methods A total of 154 patients with dyspnea, who were admitted to the emergency department of our hospital from March 2018 to September 2020, were divided into non-acute HF group (n=93) and acute HF group (n=61) according to the clinical diagnosis results. Blood routine indexes, liver and kidney function, chest radiography, electrocardiogram and echocardiography were performed, and left ventricular ejection fraction (LVEF) was determined. In addition, plasma levels of IGFBP7 and NT-proBNP were also measured. t test or chi-square test were used to compare the differences of various clinical indicators between the two groups, and logistic regression was used to analyze the risk factors of acute HF for the indices with statistical significance (P < 0.05). Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of IGFBP7, NT-proBNP and their combination for dyspnea in patients with acute HF. Results Compared with the non-acute HF group, the proportion of patients with hypertension, coronary artery disease, atrial fibrillation, plasma IGFBP7 and NT-proBNP levels were significantly increased in the acute HF group. The proportion of patients with asthma/chronic obstructive pulmonary disease (COPD), LVEF and estimated glomerular filtration rate (eGFR) were significantly decreased (all P < 0.05). Logistic regression analysis showed that the increase of IGFBP7 and NT-proBNP level and the decrease of LVEF level were risk factors for acute HF (all P < 0.05). ROC curve analysis showed that the area under curve (AUC) of IGFBP7 was 0.878 (0.821-0.935). The optimal cut-off value of IGFBP7 was 98.4 ng/mL, and the sensitivity and specificity of IGFBP7 in the diagnosis of cardiac exhaustion dyspnea were 85.2% and 82.8%. The AUC of NT-proBNP was 0.897 (0.818-0.940). The optimal cut-off value of NT-proBNP was 1 366 ng/L, and the sensitivity and specificity of the diagnosis of cardiac fatigue dyspnea were 85.2% and 89.2%. The AUC of the combined diagnosis was 0.952(0.918-0.986), the sensitivity was 88.5%, and the specificity was 92.5%. Conclusion Concentrations of IGFBP7 alone or in combination with NT-proBNP could accurately predict dyspnea caused by acute HF. IGFBP7 can be used as a novel cardiovascular biomarker for acute HF.
Key words: acute heart failure, dyspnea, insulin-like growth factor binding protein-7, N-terminal pro-B-type natriuretic peptide, diagnosis
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