远期冠状动脉支架植入术后患者血清生长分化因子15水平变化与支架内再狭窄及再发缺血性事件的关系研究  

Long-term Correlation of Serum GDF-15 Level with Coronary In-stent Restenosis and Recurrence of Ischemic Events after Coronary Stent Implantation

作　　者：林萍[1] 李鹏[1] 王琴[1] 任谦[1] LIN Ping LI Peng WANG Qin REN Qian(Department of Geriatrics, Hangzhou Third Hospital, Hangzhou 310009, China)

机构地区：[1]浙江省杭州市第三人民医院老年科,310009

出　　处：《中国全科医学》2017年第23期2848-2851,共4页Chinese General Practice

基　　金：浙江省杭州市卫生科技计划课题资助(2011A023)

摘　　要：目的探讨远期冠状动脉支架植入术后患者血清生长分化因子15(GDF15)水平变化与再发缺血性临床事件及冠状动脉支架内再狭窄的关系。方法选取2012年1月—2015年1月在杭州市第三人民医院行冠状动脉支架植入术的冠心病患者162例,将既未发生缺血事件同时冠状动脉造影无再狭窄者定义为对照组,将发生缺血相关临床事件(包括心绞痛、急性心肌梗死、心源性猝死等)者定义为缺血事件组,根据冠状动脉造影复查情况将支架内再狭窄者定义为支架内再狭窄组,再狭窄分为局限性病变亚组和非局限性病变亚组。观察冠状动脉支架植入术后1年内患者发生心绞痛、急性心肌梗死、心源性猝死等缺血相关临床事件时血清GDF15水平;同时观察冠状动脉支架植入术后9~12个月复查冠状动脉造影时血清GDF15水平与支架内再狭窄的相关性。结果心绞痛亚组、急性心肌梗死/心源性猝死亚组、对照组肌钙蛋白I(c Tn I)、C反应蛋白(CRP)、N末端脑钠肽前体(NT-pro BNP)、GDF15水平比较,差异均有统计学意义(P<0.05);其中心绞痛亚组、急性心肌梗死/心源性猝死亚组c Tn I、CRP、NT-pro BNP、GDF15水平均高于对照组(P<0.05)。局限性病变亚组、非局限性病变亚组、对照组c Tn I、CRP、NT-pro BNP、GDF15水平比较,差异均有统计学意义(P<0.05);其中局限性病变亚组、非局限性病变亚组c Tn I、CRP、NT-pro BNP、GDF15水平均高于对照组(P<0.05)。缺血事件组和支架内再狭窄组血清GDF15水平与CRP无直线相关性(rs=0.170,P=0.073),与c Tn I、NT-pro BNP水平呈正相关(rs=0.242,P=0.010;rs=0.352,P<0.001)。结论血清GDF15水平升高对冠状动脉支架植入术后再发缺血性临床事件及再狭窄具有预测价值,可能成为临床随访观察指标。Objective To investigate the long-term correlation of serum growth differentiation factor 15（ GDF15）level with the recurrence of ischemic events and coronary in-stent restenosis after coronary stent implantation. Methods Totally162 patients with coronary stent implantation in Hangzhou Third Hospital from January 2012 to January 2015 were enrolled in this study. The patients with no-ischemia events and no-restenosis were selected as control group,and the patients with ischemic events,including angina pectoris,acute myocardial infarction and sudden cardiac death were selected as ischemic events group,and the patients with in-stent restenosis were selected as in-stent restenosis group,and the patients in in-stent restenosis group were divided into localized lesion subgroup and non-localized lesion subgroup. We observed the serum GDF15 level in patients with angina pectoris,acute myocardial infarction,sudden cardiac death and other ischemic events within one year after coronary stent implantation. At the same time,we also observed the correlation between serum GDF15 level and coronary artery restenosis for those patients who reexamined coronary angiography 9-12 months after coronary stent implantation. Results The troponin（ c Tn I）,C-reactive protein（ CRP）,N-terminal brain natriuretic peptide（ NT-pro BNP） and GDF15 level differed significantly among the subgroups of angina pectoris,acute myocardial infarction/sudden cardiac death,and the control group（ P〈0. 05）. The c Tn I,CRP,NT-pro BNP,and GDF15 levels in the subgroups of angina pectoris,acute myocardial infarction/sudden cardiac death were higher than those in the control group（ P〈0. 05）. And significant differences were found in the aspects of the c Tn I,CRP,NT-pro BNP and GDF15 levels among the subgroups of localized lesion,non-localized lesion and the control group（ P〈0. 05）. The c Tn I,CRP,NT-pro BNP and GDF15 levels in the subgroups of localized lesion,non-localized lesion were higher than those in the control group（ P〈0.

关 键 词：冠心病 生长分化因子15 冠状动脉再狭窄 心肌缺血 

分 类 号：R541.4[医药卫生—心血管疾病]