血浆活化蛋白C、生长分化因子-15对心源性休克患者预后的预测价值  

Clinical significance of plasma APC and GDF-15 in the patients with cardiogenic shock

作　　者：豆哲敏 叶丹[1] 韩磊[1] 臧桂琴 Dou Zhemin;Ye Dan;Han Lei;Zang Guiqin(Department of Emergency,Beijing Aerospace General Hospital,Beijing 100076,China)

机构地区：[1]北京航天总医院急诊科,北京100076

出　　处：《中国急救医学》2025年第2期129-133,共5页Chinese Journal of Critical Care Medicine

基　　金：北京市科技发展指导性计划项目(BJSW2020012)。

摘　　要：目的研究心源性休克(CS)患者血浆活化蛋白C(APC)、生长分化因子-15(GDF-15)检测的临床意义。方法前瞻性选取2020年5月~2024年4月我院收治的102例CS患者,根据28 d存活情况将患者分为生存组(n=59)和死亡组(n=43),收集临床资料并对比两组患者血浆APC、GDF-15水平,采用多因素Logistic回归分析CS患者死亡的危险因素,并绘制受试者工作特征(ROC)曲线,评估血浆APC、GDF-15对CS患者短期预后的预测效能。结果与生存组比较,死亡组血浆APC水平降低,GDF-15水平升高(P<0.05)。与生存组比较,死亡组血乳酸显著升高(P<0.05),收缩压、动脉压、平均动脉压、血氧饱和度显著降低(P<0.05)。Logistic回归曲线显示,血乳酸、血浆GDF-15升高是CS患者短期预后不良的危险因素,血浆APC、平均动脉压、血氧饱和度升高是保护因素(P<0.05)。ROC分析显示,血浆APC、GDF-15两项联合预测CS患者死亡的曲线下面积(AUC)为0.899,敏感度、特异度分别为0.814、0.889,高于两者单独预测。结论血浆APC低表达、GDF-15高表达与CS患者死亡风险增加有关,两者联合检测对CS患者短期预后具有较高的预测价值。Objective To study the clinical significance of plasma activated protein C(APC)and growth differentiation factor-15(GDF-15)detection in the patients with cardiogenic shock(CS).Methods A total of 102 CS patients admitted to Beijing Aerospace General Hospital from May 2020 to April 2024 were prospectively selected and were divided into survival group(n=59)and death group(n=43)based on 28-day survival status,clinical data were collected and plasma APC and GDF-15 levels were compared between two groups,the risk factors for death of CS patients were analyzed by multivariate Logistic regression,the predictive efficacy of plasma APC and GDF-15 for the short-term prognosis of CS patients was analyzed by drawing receiver operating characteristic(ROC)curve.Results Compared with survival group,the plasma APC level was decreased and the GDF-15 level was increased in death group(P<0.05).Compared with survival group,the blood lactic acid in death group was significantly increased(P<0.05),and systolic blood pressure,arterial pressure,mean arterial pressure and blood oxygen saturation were significantly decreased(P<0.05).Logistic regression analysis showed that increased blood lactic acid and plasma GDF-15 were risk factors for poor short-term prognosis in CS patients,and increased plasma APC,mean arterial pressure and blood oxygen saturation were protective factors(P<0.05).ROC curve analysis showed that the area under curve(AUC),sensitivity and specificity of plasma APC combined with GDF-15 in predicting the death of CS patients were 0.899,0.814 and 0.889,respectively,which were higher than those of the single index.Conclusions The low expression of plasma APC and the high expression of GDF-15 are related to the increased risk of death in CS patients,the combined application of the two indicators has a high value in predicting the short-term prognosis of CS patients.

关 键 词：心源性休克 活化蛋白C 生长分化因子-15 短期预后 预测价值 

分 类 号：R54[医药卫生—心血管疾病]