生长分化因子15对急性胸痛早期诊断价值分析  

The value of growth differentiation factor 15 in early diagnosis of acute chest pain

作　　者：昌上清 盛云婧 邢沁蕊 杨凯迪 王婷力 郭向前 朱海燕 Chang Shangqing;Sheng Yunjing;Xing Qinrui;Yang Kaidi;Wang Tingli;Guo Xiangqian;Zhu Haiyan(Department of Emergency Medicine,Hainan Hospital of PLA General Hospital,Sanya 572013,China;Department of Emergency Medicine,The First Medical Center of PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院海南医院急诊医学科,三亚572013 [2]中国人民解放军总医院第一临床中心急诊医学科,北京100853

出　　处：《中华急诊医学杂志》2021年第6期694-698,共5页Chinese Journal of Emergency Medicine

基　　金：科技部国家重点研发计划(2019YFC0119600);联勤保障部队战勤局重大项目(ALB19J003);海南省重大科技计划(ZDKJ202004);解放军总医院转化医学项目(2018TM-06);军事医学研究专项(2018FC-WJFWXZW-1-19)。

摘　　要：目的探索生长分化因子15(growth differentiation factorl5,GDF15)在急性胸痛中的早期诊断价值.方法回顾性收集2020年1月至11月于解放军总医院海南医院急诊科就诊的急性胸痛患者96名纳入研究。记录患者性别、年龄、入院30 min内患者的肌钙蛋白T、肌酸激酶、肌酸激酶同工酶、GDF15、B型钠尿肽,比较不同组各个指标的差异。绘制ROC曲线,评价GDF15与TnT/BNP对急性冠脉综合征(acute coronary syndrome,ACS)诊断价值。统计各个患者的Gensini评分、左室射血分数、住院滞留天数以及支架植入个数,评价这些指标与GDF15浓度的相关关系。结果急性胸痛中总的趋势呈现男多女少(72.92 vs.27.08,%),年龄最大的组别为UA组,年龄为(64.67±13.87)岁,年龄最小的组别是呼吸心搏骤停组,仅为(47.29±9.99)岁。STEMI组、NSTEMI组、UA组中既往罹患高血压病比例较高,所有组别均未在既往罹患糖尿病中表现出明显优势。所有心肌标记物组间差异均有统计学意义,GDF15在ACS相关性胸痛组浓度更高[(2.360±1.710)ng/mL vs.(1.380±1.040)ng/mL,P<0.01]。GDF15与TnT联合对于诊断ACS相关性胸痛的价值最高,其工作特征曲线下面积(the area under the receiver operating characteristic,AUC)可达0.863。GDF15浓度与心脏射血分数负相关,Gensini评分正相关,植入支架个数正相关,患者住院天数正相关。结论GDF15在急性胸痛中具有很好的诊断及预后预测价值。GDF15与TnT联合可提高ACS诊断率。Objective To explore the value of growth differentiation factor 15(GDF15)in the early diagnosis of acute chest pain.Methods A total of 96 patients with acute chest pain admitted to the Emergency Department of Hainan Hospital of PLA General Hospital from January to November 2020 were retrospectively collected.The sex,age,troponin T,creatine kinase,creatine kinase isoenzyme,GDF15 and B-type natriuretic peptide of patients within 30 min after admission were recorded,and the differences of each index in different groups were compared.ROC curve was drawn to evaluate the diagnostic value of GDF15 and TNT/BNP in acute coronary syndrome(ACS).The Gensini score,left ventricular ejection fraction,length of stay in hospital and the number of stents were calculated,and the correlation between these indexes and GDF15 concentration was evaluated.Results The general trend of acute chest pain was more male than female(72.92%vs.27.08%),the oldest group was the UA group(64.67±13.87)years old,the youngest group was cardiac arrest group(47.29±9.99)years old.There were higher rates of hypertension in the STEMI group,NSTEMI group and UA group,and none of the groups showed significant advantage in diabetes.The GDF15 concentration was higher in ACS related chest pain group[(2.360±1.710)ng/mL vs.(1.380±1.040)ng/mL,P<0.01].The area under the Receiver Operating Characteristic Curve(AUC)of GDF15 combined with TNT was up to 0.863.GDF15 concentration was negatively correlated with ejection fraction,positively correlated with Gensini score,positively correlated with the number of stents implanted,and positively correlated with the length of hospital stay.Conclusions GDF15 is valuable in the diagnosis and prognosis of acute chest pain.The combination of GDF15 and TNT can improve the diagnostic rate of ACS.

关 键 词：急性胸痛 生长分化因子15 心肌标记物 急性冠脉综合征 肌钙蛋白T 肌酸激酶 肌酸激酶同工酶 B型钠尿肽 早期诊断 

分 类 号：R541.4[医药卫生—心血管疾病]