慢性心力衰竭患者血浆IGFBP2、SMOC2水平与心功能及预后的关系

doi:10.11958/20250289

天津医药 ›› 2025, Vol. 53 ›› Issue (6): 593-598.doi: 10.11958/20250289

慢性心力衰竭患者血浆IGFBP2、SMOC2水平与心功能及预后的关系

董玉婷¹(), 龚雪莲²^,^△(), 屈超²

1 西安交通大学第一附属医院东院区检验科（邮编710089）
2 西安市第五医院心血管一科

收稿日期:2025-01-16 修回日期:2025-03-20 出版日期:2025-06-15 发布日期:2025-06-20
通讯作者: ^△E-mail：Xuelian10256@163.com
作者简介:董玉婷（1990），女，主管技师，主要从事心肌标志物、肿瘤免疫方面研究。E-mail：dongyuting100315@163.com
基金资助:
陕西省卫生健康科研基金项目(2022D045)

The relationship between plasma IGFBP2, SMOC2 levels and cardiac function and prognosis in patients with chronic heart failure

DONG Yuting¹(), GONG Xuelian²^,^△(), QU Chao²

1 Department of Clinical Laboratory, East District of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710089, China
2 the 1st Department of Cardiovascular Medicine, the Fifth Hospital of Xi'an

Received:2025-01-16 Revised:2025-03-20 Published:2025-06-15 Online:2025-06-20
Contact: ^△E-mail: Xuelian10256@163.com

董玉婷, 龚雪莲, 屈超. 慢性心力衰竭患者血浆IGFBP2、SMOC2水平与心功能及预后的关系[J]. 天津医药, 2025, 53(6): 593-598.

DONG Yuting, GONG Xuelian, QU Chao. The relationship between plasma IGFBP2, SMOC2 levels and cardiac function and prognosis in patients with chronic heart failure[J]. Tianjin Medical Journal, 2025, 53(6): 593-598.

摘要/Abstract

摘要：

目的探讨慢性心力衰竭（CHF）患者血浆胰岛素样生长因子结合蛋白2（IGFBP2）、分泌型模块化钙结合蛋白2（SMOC2）水平与心功能及预后的关系。方法选取CHF患者120例（CHF组）和同期健康体检志愿者60例（对照组），CHF患者根据NYHA心功能分级分为Ⅱ级组（46例）、Ⅲ级组（42例）、Ⅳ级组（32例），根据6个月预后分为不良预后组和良好预后组。采用酶联免疫吸附试验检测血浆IGFBP2、SMOC2水平。通过Spearman等级相关分析CHF患者血浆IGFBP2、SMOC2水平与NYHA心功能分级的相关性；多因素非条件Logistic回归分析血浆IGFBP2、SMOC2水平与CHF患者不良预后的关系；受试者工作特征（ROC）曲线分析血浆IGFBP2、SMOC2水平对预后的预测效能。结果与对照组比较，CHF组血浆IGFBP2、SMOC2水平升高（P<0.05）。Ⅱ级组、Ⅲ级组、Ⅳ级组血浆IGFBP2、SMOC2水平依次升高（P<0.05）。CHF患者血浆IGFBP2、SMOC2水平与NYHA心功能分级呈正相关（P<0.05）。120例CHF患者6个月不良预后率为35.00%（42/120）。与良好预后组比较，不良预后组血浆IGFBP2、SMOC2水平升高（P<0.05）。调整混杂因素后，IGFBP2高、SMOC2高为CHF患者不良预后的独立危险因素（P<0.05）。血浆IGFBP2、SMOC2水平联合预测CHF患者不良预后的曲线下面积为0.899，高于各自单独预测的0.800、0.782（P<0.05）。结论 CHF患者血浆IGFBP2、SMOC2水平升高，与心功能降低和预后不良有关，血浆IGFBP2、SMOC2水平联合检测对CHF患者预后有较高的预测效能。

关键词: 心力衰竭, 预后, 胰岛素样生长因子结合蛋白质2, 分泌型模块化钙结合蛋白2

Abstract:

Objective To explore the relationship between plasma insulin-like growth factor-binding protein 2 (IGFBP2), secreted modular calcium-binding protein 2 (SMOC2) levels and cardiac function and prognosis in patients with chronic heart failure (CHF). Methods A total of 120 CHF patients (the CHF group) and 60 healthy volunteers undergoing physical examination during the same period (the control group) were enrolled. CHF patients were classified according to the New York Heart Association (NYHA) functional classification into the class Ⅱ (46 cases) group, the class Ⅲ group (42 cases) and the class Ⅳ group (32 cases). Based on the 6-month prognosis, patients were further divided into the poor prognosis group (42 cases) and the good prognosis group (78 cases). Plasma IGFBP2 and SMOC2 levels were measured using enzyme-linked immunosorbent assay. The correlation between plasma IGFBP2 and SMOC2 levels with NYHA functional classification was analyzed using Spearman rank correlation. Multivariate unconditional Logistic regression was used to analyze the relationship between plasma IGFBP2 and SMOC2 levels and poor prognosis in CHF patients. The predictive efficacy of plasma IGFBP2 and SMOC2 levels for CHF prognosis was evaluated using receiver operating characteristic (ROC) curve analysis. Results Compared with the control group, plasma IGFBP2 and SMOC2 levels were significantly higher in the CHF group (P<0.05). Plasma IGFBP2 and SMOC2 levels increased progressively in the class Ⅱ group, the class Ⅲ group and the class Ⅳ group (P<0.05). Plasma IGFBP2 and SMOC2 levels were positively correlated with NYHA classification of CHF patients (P<0.05). The 6-month poor prognosis rate for the 120 CHF patients was 35.00% (42/120). Compared with the good prognosis group, the plasma IGFBP2 and SMOC2 levels were significantly higher in the poor prognosis group (P<0.05). After adjusting for confounding factors, high levels of IGFBP2 and SMOC2 were independent risk factors for poor prognosis in CHF patients (P<0.05). The area under the curve (AUC) for the combined prediction of poor prognosis in CHF patients by plasma IGFBP2 and SMOC2 levels was 0.899, which was higher than that of plasma IGFBP2 (0.800) and SMOC2 (0.782) alone (P<0.05). Conclusion The plasma levels of IGFBP2 and SMOC2 in CHF patients are increased, which is related to the decrease of cardiac function and poor prognosis. The combination of plasma IGFBP2 and SMOC2 levels has a high predictive efficiency for the prognosis of CHF patients.

Key words: heart failure, prognosis, insulin-like growth factor-binding protein 2, secreted modular calcium-binding protein 2

中图分类号:

R541.62

图/表 6

参考文献 24

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组别	n	性别（男/女）	年龄/岁	IGFBP2/（μg/L）	SMOC2/（ng/L）
对照组	60	38/22	57.85±8.30	533.43±206.61	676.70±305.20
CHF组	120	70/50	59.93±10.13	893.84±189.93	1 264.86±334.44
χ²或t		0.519	0.171	11.653^＊＊	11.444^＊＊

组别	n	性别（男/女）	年龄/岁	IGFBP2/（μg/L）	SMOC2/（ng/L）
对照组	60	38/22	57.85±8.30	533.43±206.61	676.70±305.20
CHF组	120	70/50	59.93±10.13	893.84±189.93	1 264.86±334.44
χ²或t		0.519	0.171	11.653^＊＊	11.444^＊＊

组别	n	IGFBP2/（μg/L）	SMOC2/（ng/L）
Ⅱ级组	46	767.24±132.98	1 010.02±263.71
Ⅲ级组	42	873.86±95.31^a	1 258.23±202.78^a
Ⅳ级组	32	1 102.03±178.11^ab	1 639.89±180.01^ab
F		115.021^＊＊	150.522^＊＊

组别	n	IGFBP2/（μg/L）	SMOC2/（ng/L）
Ⅱ级组	46	767.24±132.98	1 010.02±263.71
Ⅲ级组	42	873.86±95.31^a	1 258.23±202.78^a
Ⅳ级组	32	1 102.03±178.11^ab	1 639.89±180.01^ab
F		115.021^＊＊	150.522^＊＊

组别			n	性别（男/女）			年龄/岁		NYHA心功能分级（Ⅱ级/Ⅲ级/Ⅳ级）			吸烟史			饮酒史			糖尿病	高血压			冠心病
良好预后组			78	44/34			58.35±11.11		43/26/9			23（29.5）			13（16.7）			20（25.6）	58（74.4）			36（46.2）
不良预后组			42	26/16			62.86±7.23		3/16/23			18（42.9）			11（26.2）			16（38.1）	32（76.2）			20（47.6）
χ²、t或Z				0.339			2.683^＊		5.935^＊＊			2.170			1.548			2.016	0.049			0.024
组别		心房颤动			高脂血症			收缩压/mmHg			舒张压/mmHg			LVEF		NT-proBNP/（ng/L）					白蛋白/（g/L）
良好预后组		22（28.2）			19（24.4）			138.68±16.62			82.65±13.84			0.52±0.07		2 380.6±936.0					37.04±6.03
不良预后组		20（47.6）			14（33.3）			142.95±18.43			86.31±16.43			0.48±0.04		3 293.1±1 235.1					35.07±5.38
χ²或t		4.523^＊			1.103			1.293			1.291			3.696^＊＊		4.542^＊＊					1.777
组别	血尿酸/（μmol/L）					总胆红素/（μmol/L）				血肌酐/（μmol/L）			血尿素氮/（mmol/L）				IGFBP2/（μg/L）			SMOC2/（ng/L）
良好预后组	474.03±146.67					15.22±3.94				82.17±33.66			10.88±3.86				827.15±157.31			1 148.92±310.39
不良预后组	509.79±171.21					14.00±4.04				90.24±29.97			12.22±4.01				1 017.67±184.54			1 480.17±265.78
t	1.200					1.597				1.301			1.797				5.591^＊＊			5.854^＊＊

慢性心力衰竭患者血浆IGFBP2、SMOC2水平与心功能及预后的关系

The relationship between plasma IGFBP2, SMOC2 levels and cardiac function and prognosis in patients with chronic heart failure

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变量	β	SE	Wald χ²	P	OR	OR 95%CI
年龄	0.055	0.038	2.107	0.147	1.056	0.981~1.137
NYHA心功能分级			5.414	0.067
Ⅲ级	0.644	0.703	0.839	0.360	1.904	0.480~7.553
Ⅳ级	1.956	0.844	5.372	0.020	7.074	1.352~36.995
心房颤动	0.847	0.649	1.701	0.192	2.333	0.653~8.332
LVEF	-0.078	0.047	2.775	0.096	0.925	0.844~1.006
NT-proBNP	0.001	0.000	7.000	0.008	1.001	1.000~1.001
IGFBP2	0.007	0.002	12.797	<0.001	1.007	1.003~1.011
SMOC2	0.005	0.001	12.589	<0.001	1.005	1.002~1.007
常数项	-17.288	5.186	11.113	0.001	<0.001

指标	AUC	95%CI	截断值	敏感度/ %	特异度/ %	约登指数
IGFBP2	0.800	0.718~0.868	913.04 μg/L	71.43	84.62	0.560
SMOC2	0.782	0.697~0.852	1 243.91 ng/L	88.10	56.41	0.445
二者联合	0.899	0.831~0.946	-	78.57	88.46	0.670

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