血清生长分化因子-15与急性冠状动脉综合征的相关性分析  

Correlation between levels of serum growth differentiation factor-15 and acute coronary syndrome

作　　者：郑凌冰[1] 郭艳红[1] 于海奕[1] 米琳[1] 汪宇鹏[1] 高炜[1] 

机构地区：[1]北京大学第三医院心内科,分子心血管学教育部重点实验室,北京100191

出　　处：《北京大学学报（医学版）》2011年第2期250-254,共5页Journal of Peking University:Health Sciences

基　　金：国家重点基础研究发展计划(2007CB512107)资助~~

摘　　要：目的：观察急性冠状动脉综合征患者血清中生长分化因子-15（growth differentiation factor-15,GDF-15）的水平与患者年龄、病史及相关实验室检查结果之间的关联性,探讨其产生的可能机制。方法：采用前瞻性研究方法,入选进行冠状动脉造影检查的患者120例为研究对象,包括急性冠状动脉综合征组90例（急性心肌梗死早期组、急性心肌梗死714 d组和不稳定型心绞痛组各30例）和对照组30例。采用酶联免疫吸附法测定患者血清GDF-15浓度,采用logistic回归分析多因素与GDF-15水平之间的关联性。结果：急性冠状动脉综合征组GDF-15水平[（649.0±224.21）ng/L]显著高于对照组[（537.2±262.9）ng/L,P〈0.01],其中,急性心肌梗死早期组GDF-15水平[（801.6±218.4）ng/L]显著高于急性心肌梗死714 d组[（656.2±252.4）ng/L,P〈0.05,95%CI1.0011.061]、不稳定型心绞痛组[（586.9±225.6）ng/L,P〈0.01,95%CI0.8090.950]和对照组（P〈0.05,95%CI1.0001.012）。多元logistic回归筛选与GDF-15水平产生相关的因素为患者白细胞计数（r2=0.276,P〈0.01）、乳酸脱氢酶（r2=0.288,P〈0.01）、肌酸激酶MB同工酶（r2=0.350,P〈0.01）和肌钙蛋白T（r2=0.344,P〈0.01）均具有相关性。结论：急性冠状动脉综合征患者血清GDF-15水平显著高于冠状动脉造影正常者,急性心肌梗死早期升高更明显,其水平与肌酸激酶MB同工酶、肌钙蛋白T、乳酸脱氢酶和白细胞等生物学标志物相关,提示GDF-15可能是一个新的心血管疾病生物标志物。Objective：To explore the association between the levels of serum growth differentiation factor-15（GDF-15） and acute coronary syndrome（ACS） in patients undergoing coronary angiography（CAG）.Methods： In this prospective study,120 candidates（30 healthy controls and 90 patients with ACS）admitted to our hospital from March 2006 to April 2008 were included.The patients with ACS were divided into 3 groups：（1）Group AMI-emergency（AMI-E）,including 30 patients with acute myocardial infarction（AMI）who underwent CAG within 12 hours of the onset of symptoms.（2） Group AMI 7-14 d,including 30 patients with AMI who underwent CAG within 7-14 days of the onset of symptoms.（3）Group UAP including 30 patients with unstable angina pectoris.The serum level of GDF-15 was determined by ELISA.Results： The level of GDF-15 for group ACS was（649.0 ± 224.21） ng/L,which was significantly higher than that of control group[（537.2±262.9）ng/L,P〈0.01].The level of serum GDF-15 significantly increased in group AMI-E [（801.6±218.4）ng/L] compared with group AMI 7-14 d[（656.2±252.4）ng/L,P=0.042,95% CI 1.001-1.061],group UAP[（586.9±225.6）ng/L,P=0.001,95% CI 0.809-0.950]and control group（P〈0.05,95% CI 1.000-1.012） after being adjusted for relevant covariates.The elevated level of GDF-15 was related to biomarkers,such as white blood cells count（WBC,r2 =0.276,P=0.002）,lactate dehyerogenase（LDH,r2 = 0.288,P=0.004）,creatine kinase 2（CK-MB,r2 = 0.350,P〈0.001）and troponin T（TnT,r2 =0.344,P=0.001）.Conclusion： GDF-15 protein expression increases in ACS,and the level of GDF-15 rapidly increases and remains elevated in the early period of acute myocardial infarction.The elevated level of GDF-15 is related to biomarkers,such as WBC,LDH,CK-MB,and TnT.GDF-15 could be a new and independent biomarker in evaluating the patients with cardiovascular disease.

关 键 词：生长分化因子-15 急性冠状动脉综合征 心肌梗死 

分 类 号：R543.3[医药卫生—心血管疾病]