心肺复苏患者血清GDF-15、NT-proBNP、cTnI水平变化的临床意义及其与近期预后的关系  

Clinical significance of changes of serum GDF-15,NT-proBNP and cTnI levels and its relationship with short-term prognosis in patients with cardiopulmonary resuscitation

作　　者：于海侠[1] 周景霞[2] 任长安[1] 武会志 李忠[1] 刘春涛[2] 

机构地区：[1]承德市中心医院急诊科,河北省承德市067000 [2]承德市中心医院重症医学二病区,河北省承德市067000

出　　处：《中国动脉硬化杂志》2017年第3期269-273,共5页Chinese Journal of Arteriosclerosis

基　　金：承德市科学技术研究与发展计划项目(20142009)

摘　　要：目的探讨心脏骤停心肺复苏(CPR)成功后的患者血清生长分化因子15(GDF-15)、N端B型利钠肽原(NT-proBNP)、心肌肌钙蛋白I(c Tn I)不同时间水平变化的临床意义及与近期预后的关系。方法分别检测102例CPR患者CPR后即刻、12 h、24~48 h的血清GDF-15水平,根据血清GDF-15升高时间分为3组:(1)A组:CPR后即刻、12 h、24~48 h GDF-15水平一直小于1200 ng/L;(2)B组:CPR后12 h和24~48 h GDF-15水平均升高,且大于1200 ng/L;(3)C组:CPR后即刻和12 h GDF-15水平升高,24~48 h GDF-15水平较12 h时降低。同时检测3组患者各时间点血清NT-proBNP、cTnI水平及左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)。随访3组患者CPR后6个月的死亡情况。结果 GDF-15与NT-pro BNP、cTnI具有交互作用(P=0.001)。LVEDD、LVEF随着GDF-15、NT-pro BNP、cTnI水平的变化而变化。GDF-15、NT-pro BNP、cTnI高水平组患者死亡率均高于GDF-15、NT-pro BNP、cTnI低水平组(P<0.05)。生存率分析结果显示,6个月生存率A组高于B组(χ~2=12.738,P=0.001),B组较C组低(χ~2=7.253,P=0.009),A组和C组无显著差异(χ2=2.240,P=0.097)。结论血清GDF-15、NT-proBNP、cTnI水平是预测CPR患者近期预后的很好指标,联合检测意义更大。Aim To investigate the clinical significance of serum growth differentiation factor 15 （GDF-15） , N- terminal pro-B-type natriuretic peptide （ NT-proBNP）, cardiac troponin I （cTnI） changes at different time and its relation- ship with short-term prognosis in patients with cardiac arrest cardiopulmonary resuscitation. Methods The serum levels of GDF-15 were detected in 102 CPR patients at instant time, 12 h, 24-48 h after CPR. According to the rise time of serum GDF-15, the patients were divided into 3 groups： （1）A group： at instant time, 12 h, 24-48 h after CPR, GDF- 15 levels had been less than 1200 ng/L; （2）B group： at 12 h and 24-48 h after CPR, GDF-15 levels were increased, and more than 1200 ng/L; （3）C group： at instant time, 12 h after CPR, GDF-15 levels were increased, but GDF-15 level at 24-48 h was lower than that at 12 h. At each time point, the serum levels of NT-proBNP and cTnI, left ventricular end- diastolic diameter （LVEDD） and left ventricular ejection fraction （LVEF） were detected at the same time in 3 groups. The death situation of 3 groups was followed up for 6 months after CPR. Results GDF-15 had an interaction with NT- proBNP and cTnI （P=0.001）. LVEDD and LVEF were changed with the changes of GDF-15, NT-proBNP and cTnI levels. The mortality rates of patients in GDF-15, NT-proBNP and cTnI high level groups were higher than those in GDF-15, NT-proBNP and cTnI low level groups （P〈0.05）. Survival analysis results showed that the 6 month survival rate of A group was higher than that of B group （x^2 = 12.738, P= 0.001 ） , the 6 month survival rate of B group was lower than that of C group （x^2 =7.253, P=0.009） , and there was no significant difference in 6 month survival rate between A group and C group （x^2= 2.240, P= 0.097）. Conclusion The serum levels of GDF-15, NT-proBNP and cTnl are good indicators for predicting the short-term prognosis of CPR patients, and the significance of combined detection is even higher.

关 键 词：心肺复苏 生长分化因子15 N端B型利钠肽原 心肌肌钙蛋白I 近期预后 

分 类 号：R459.7[医药卫生—急诊医学]