血清生长分化因子15与出血评分联合应用对冠心病患者PCI治疗后出血的预测效能  

Predictive efficacy of serum growth differentiation factor 15 combined with bleeding score on bleeding after PCI in patients with coronary artery disease

作　　者：王昱冕 邹继宏 陈涵 张黎 柳民 崔芸 王红 宋莹 WANG Yumian;ZOU Jihong;CHEN Han;ZHANG Li;LIU Min;CUI Yun;WANG Hong;SONG Ying(Department of Cardiology,Yunnan Fuwai Cardiovascular Hospital/Cardiovascular Hospital of Kunming Medical University,Kunming 650102,China;不详)

机构地区：[1]云南省阜外心血管病医院,昆明医科大学附属心血管病医院心内科,昆明650102 [2]中国医学科学院阜外医院心内科

出　　处：《山东医药》2023年第12期22-27,共6页Shandong Medical Journal

基　　金：云南省阜外心血管病医院心力衰竭诊疗省创新团队项目(202005AE160020);云南省心血管病临床医学中心项目(2020YFKT-07)。

摘　　要：目的分析血清生长分化因子15(GDF-15)与出血评分联合应用对冠心病(CAD)患者经皮冠状动脉介入(PCI)治疗后出血的预测效能。方法225例CAD患者按照PCI治疗后是否出血分为出血组(31例)和未出血组(194例),比较两组血清生长分化因子15水平及出血评分(HAS-BLED出血评分和CRUSADE出血评分),采用多因素Logistic回归分析法分析CAD患者PCI治疗后出血的影响因素和危险因素。绘制受试者工作特征曲线(ROC),分析血清GDF-15、HAS-BLED出血评分、CRUSADE出血评分单独及联合对CAD患者PCI治疗后出血的预测效能。结果出血组和未出血组女性比例、血清GDF-15水平、HASB-LED出血评分、CRUSADE出血评分比较,P均<0.05。多因素Logistic回归分析显示,血清GDF-15水平[OR(95%CI)=13.408(3.130~57.442),P=0.000]、HAS-BLED出血评分[OR(95%CI)=2.394(1.313~4.364),P=0.004]、CRUSADE出血评分[OR(95%CI)=1.065(1.010~1.123),P=0.019]与出血事件有关。当血清GDF-15临界值为2467.61 pg/mL时,其对CAD患者PCI治疗后出血的预测灵敏度为51.6%,特异度为86.1%,ROC下面积为0.720,95%CI为0.623~0.817,P<0.05;当HAS-BLED出血评分的临界值为2分时,其对CAD患者PCI治疗后出血的预测灵敏度为74.2%,特异度为68.8%,ROC下面积为0.730,95%CI为0.635~0.825,P<0.05;当CRUSADE出血评分的临界值为30分时,其对出血事件的预测灵敏度为77.4%,特异度为55.2%,ROC下面积为0.689,95%CI为0.596~0.781,P<0.05;血清GDF-15联合HAS-BLED出血评分对CAD患者PCI治疗后出血的预测灵敏度为74.2%,特异度为78.9%,ROC下面积为0.794,95%CI为0.711~0.876;血清GDF-15联合CRUSADE出血评分对CAD患者PCI治疗后出血的预测灵敏度为87.1%,特异度为61.3%,ROC下面积为0.788,95%CI为0.711~0.865;GDF-15与GDF-15联合HAS-BLED出血评分比较,P<0.05。结论血清GDF-15、HAS-BLED出血评分、CRUSADE出血评分均是CAD患者PCI术后出血风险有效预测指标,两指标联合应用预测效能高于单指标。Objective To analyze the predictive efficacy of serum growth differentiation factor 15(GDF-15)in com⁃bination with the bleeding score on bleeding after percutaneous coronary intervention(PCI)in patients with coronary artery disease(CAD).Methods Totally 225 CAD patients were divided into the bleeding group(31 patients)and non-bleed⁃ing group(194 patients)according to whether they bled after PCI treatment,and the serum GDF-15 levels and bleeding scores(HAS-BLED bleeding score and CRUSADE bleeding score)of the two groups were compared.Multi-factor Logistic regression analysis was used to analyze the influencing factors and risk factors for bleeding after PCI treatment in CAD pa⁃tients.Receiver operating characteristic(ROC)curves were plotted to examine the predictive efficacy of serum GDF-15,HAS-BLED bleeding score,and CRUSADE bleeding score alone and in combination on bleeding after PCI treatment in CAD patients.Results Significant differences were found in the proportion of women,serum GDF-15 levels,HASB-BLED bleeding score,and CRUSADE bleeding score between the bleeding and non-bleeding groups(all P<0.05).Multi⁃factorial Logistic regression analysis showed that serum GDF-15 level[OR(95%CI)=13.408(3.130 to 57.442),P=0.000],HAS-BLED bleeding score[OR(95%CI)=2.394(1.313 to 4.364),P=0.004],and CRUSADE bleeding score[OR(95%CI)=1.065(1.010 to 1.123),P=0.019]were associated with bleeding events.When the critical value of se⁃rum GDF-15 was 2467.61 pg/mL,its predictive sensitivity for bleeding after PCI treatment in CAD patients was 51.6%,specificity was 86.1%,and area under ROC was 0.720(95%CI:0.623 to 0.817,P<0.05);when the critical value of HAS-BLED bleeding score was 2,its predictive sensitivity for bleeding after PCI treatment in patients was 74.2%,speci⁃ficity was 68.8%,and area under ROC was 0.730,(95%CI:0.635 to 0.825,P<0.05);when the critical value of CRU⁃SADE bleeding score was 30,its predictive sensitivity for bleeding events was 77.4%,specificity was 55.2%,and area under ROC was 0.689(95%CI:0.596

关 键 词：生长分化因子15 HAS-BLED出血评分 CRUSADE出血评分 冠状动脉粥样硬化性心脏病 经皮冠状动脉介入 出血 

分 类 号：R541.4[医药卫生—心血管疾病]