Adropin and Irisin in Patients with Cardiac Cachexia

Abstract Background: Cardiac cachexia is an important predictive factor of the reduction in survival of patients with heart failure with reduced ejection fraction. Objectives: The aims of the present study were to evaluate adropin and irisin levels in cachectic and non-cachectic subjects and the relationships between the levels of these proteins and clinical and laboratory parameters in patients with HFrEF. Methods: The clinical records of patients who were admitted to the cardiology outpatient clinic for heart failure with reduced ejection fraction were screened. Cachectic patients were identified and assigned to the study group (n = 44, mean age, 65.4 ± 11.2 y; 61.4% men). Heart failure with reduced ejection fraction patients without weight loss were enrolled as the control group (n = 42, mean age, 61.0 ± 16.5 y; 64.3% men). The serum adropin and irisin levels of all patients were measured. A p-value < 0.05 was considered significant. Results: Serum adropin and irisin levels were significantly higher in the cachexia group than in the controls (Adropin (ng/L); 286.1 (231.3-404.0) vs 213.7 (203.1-251.3); p < 0.001, Irisin (µg/mL); 2.6 (2.2-4.4) vs 2.1 (1.8-2.4); p = 0.001). Serum adropin and irisin levels were positively correlated with brain natriuretic peptide (BNP) levels and New York Heart Association (NYHA) class and negatively correlated with body mass index (BMI) and serum albumin levels (all p values: < 0.001). In a multivariate analysis, adropin was the only independent predictor of cachexia in the heart failure with reduced ejection fraction patients (OR: 1.021; 95% CI: 1.004−1.038; p = 0.017). Conclusions: The results suggest that adropin and irisin may be novel markers of cardiac cachexia in heart failure with reduced ejection fraction patients. Adropin and irisin are related with the severity of heart failure.

摘要 背景：心脏恶病质（cardiac cachexia）是射血分数降低型心力衰竭（heart failure with reduced ejection fraction，HFrEF）患者生存率下降的重要预测因素。目的：本研究旨在评估恶病质与非恶病质受试者的阿德罗平（adropin）与鸢尾素（irisin）水平，以及射血分数降低型心力衰竭患者中这两种蛋白水平与临床及实验室指标的相关性。方法：本研究筛选了因射血分数降低型心力衰竭就诊于心血管门诊的患者病历。将确诊的恶病质患者纳入研究组（n=44，平均年龄65.4±11.2岁；男性占比61.4%）；将无体重下降的射血分数降低型心力衰竭患者纳入对照组（n=42，平均年龄61.0±16.5岁；男性占比64.3%）。检测所有受试者的血清阿德罗平与鸢尾素水平，以p值<0.05作为差异具有统计学意义的判定标准。结果：恶病质组患者的血清阿德罗平与鸢尾素水平均显著高于对照组[阿德罗平（ng/L）：286.1（231.3~404.0） vs 213.7（203.1~251.3）；p<0.001；鸢尾素（μg/mL）：2.6（2.2~4.4） vs 2.1（1.8~2.4）；p=0.001]。血清阿德罗平与鸢尾素水平均与脑钠肽（brain natriuretic peptide，BNP）水平及纽约心脏病协会（New York Heart Association，NYHA）心功能分级呈正相关，与体重指数（body mass index，BMI）及血清白蛋白水平呈负相关（所有p值均<0.001）。多因素分析结果显示，阿德罗平是射血分数降低型心力衰竭患者发生恶病质的唯一独立预测因子（比值比OR：1.021；95%置信区间CI：1.004~1.038；p=0.017）。结论：本研究结果表明，阿德罗平与鸢尾素或可作为射血分数降低型心力衰竭患者心脏恶病质的新型生物标志物，且二者与心力衰竭严重程度密切相关。