慢性心力衰竭急性加重患者血清生长分化因子-15水平及其对预后的评估意义  

Serum levels of growth differentiation factor-15 in patients with acute exacerbation of chronic heart failure and its prognostic significance

作　　者：关敬树 周云 缪志静 张超 施珊岚 

机构地区：[1]上海宝山中西医结合医院心内科,上海201900

出　　处：《中国医师杂志》2016年第5期680-683,687,共5页Journal of Chinese Physician

基　　金：上海市宝山区科学技术委员会科研基金项目，Research Science and Technology Commission of Baoshan District of Shanghai

摘　　要：目的 探讨慢性心力衰竭（CHF）急性加重患者血清生长分化因子-15（GDF-15）水平及其与常用指标的相关性,旨在为CHF的临床诊疗和预后判断提供参考.方法 选取CHF急性加 重患者200例,设为CHF组;另匹配性选取健康志愿者100例,设为对照组.CHF组患者分别于入院2h内、症状好转出院前,对照组受试者于体检当日,检测血清GDF-15、N末端脑钠肽原（NT-proBNP）水平,进行超声心动图检查以测量左室收缩末期内径（LVESD）、左室舒张末期内径（LVEDD）,计算左室射血分数（LVEF）.随访2年记录CHF相关不良事件.Spearman相关分析检验GDF-15与其他指标间的相关性,绘制受试者工作特征曲线（ROC）并计算曲线下面积（AUC）以分析评估指标诊断CHF的价值.结果 CHF组患者各时点血清GDF-15及NT-proBNP水平均高于对照组（t =4.70-7.11,P＜0.05或P＜0.01）,血清GDF-15、NT-proBNP水平与LVEF均呈负相关（r=-0.539、-0.572,P＜0.01）,与LVESD、LVEDD、NYHA心功能分级均呈正相关（r=0.505 -0.861,P＜0.01）;血清GDF-15与NT-proBNP水平呈正相关（r=0.528,P＜0.01）.随着血清GDF-15水平升高,再入院率、死亡率增高（χ^2=36.86、26.59,P＜0.01）.血清GDF-15预测再入院风险的AUC为0.822（95％ CI：0.719 -0.890,P＜0.01）,最佳预测截点为2876.30ng/L（敏感度为91.86％,特异度为73.27％）;预测死亡风险的AUC为0.816（95％ CI：0.715 -0.885,P＜0.01）,最佳预测截点为3487.05ng/L（敏感度为91.72％,特异度为69.05％）.结论 CHF急性加重患者血清GDF-15水平较高,随着症状好转而降低,且与NT-proBNP、NYHA心功能分级均呈正相关,与LVEF呈负相关,在预测CHF相关不良事件风险方面具有较高的敏感度,其机制可能与激活SMAD通路有关,在心血管系统疾病的临床诊疗和预后判断方面可能是比较有前景的生物标记物.Objective To explore the serum levels of growth differentiation factor-15 （GDF-15） in patients with acute exacerbation of chronic heart failure （CHF） and its correlation with other common indexes,to provide reference for its clinical diagnosis,treatment and prognosis.Methods Two hundred patients with acute exacerbation of CHF were selected as CHF group,and 100 matched healthy volunteers were selected as control group.Serum levels of GDF-15 and N-terminal pronatriuretic peptide （NT-proBNP） were detected,and left ventricular end diastolic diameter （LVESD）,left ventricular end diastolic diameter （LVEDD）,and left ventricular ejection fraction （LVEF） were measured by echocardiography within 2 hours after admitted to hospital,and after the symptoms improved of CHF group,and on health examination day of control group.Patients in CHF group were followed up to record CHF related adverse events.Correlations between GDF-15 and other indicators were analyzed by Spearman correlation analysis,and the clinical value of serum GDF-15 on diagnosing CHF was analyzed by the receiver operating characteristic curve （ROC） and the area under the curve （AUC）.Results The serum levels of GDF-15 and NT-proBNP in each time-point of CHF group were all higher than those of control group （t =4.70 - 7.11,P 〈 0.05 orP 〈 0.01）.The serum levels of GDF-15 and NT-proBNP had negative correlation with LVEF （r =-0.539,-0.572,P 〈 0.01）,and had positive correlation with LVESD,LVEDD,and NYHA cardiac functional grading （r =0.505 - 0.861,P 〈 0.01）.Serum GDF-15 had positive correlation with serum NT-proBNP （r =0.528,P 〈0.01）.With the increase of serum GDF-15 level,CHF group＇s readmission （rate） and death （rate） were both increased （χ^2 =36.86,26.59,P 〈0.01）.AUC of predicting readmission risk by serum GDF-15 was 0.822 （95% CI：0.719 -0.890,P 〈0.01）,and the best predictive cutoff point was 2 876.30 ng/L （sensitivity was 91.86%,specificity was 73.27%）.AUC of predicting mortalit

关 键 词：心力衰竭/代谢 胞间信号肽类和蛋白质类/代谢 预后 

分 类 号：R541.6[医药卫生—心血管疾病]