摘要
目的 探讨生长分化因子15（GDF-15）与冠心病患者慢性心力衰竭的关系及诊断价值.方法 选择复旦大学附属华山医院心内科269例行冠状动脉造影（CAG）检查的患者,根据CAG、心电图及心肌酶学检查结果分为3组：其中冠心病心肌梗死患者98例（MI组）,本组再根据纽约心脏病协会（NYHA）心功能分级Ⅰ～Ⅳ级分为4个亚组;未经历心肌梗死的冠心病患者84例（CAD组）;CAG正常患者87例（对照组）.采用酶联免疫吸附法测定患者GDF-15浓度.分析GDF-15与NYHA分级和血清N末端脑钠肽原（NT-proBNP）的关系.结果 MI组平均及其各不同心功能分级亚组[纽约心脏病协会（NYHA）Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级]、CAD组血清GDF-15浓度明显高于对照组,差异有统计学意义[1 622（888,1 995）,983 （808,1 501）、1 614（810,1 825）、1 940（1 837,2 063）、3 905（3 690,4 019）,945（856,1 000） ng/L比798 （728,873） ng/L] （P ＜0.05）.MI组平均及其各不同心功能分级亚组（NYHA Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级）血清NT-proBNP浓度明显高于对照组,差异有统计学意义[564（158,857）,233（105,552）、278（133,716）、790（636,1 490）、4 665（3 712,5 442） ng/L比121（108,134）ng/L] （P ＜0.05）.相关性分析显示GDF-15水平与血清NT-proBNP水平呈显著正相关（r=0.861,P＜0.01）,与血清LVEF呈显著负相关（r=-0.936,P＜0.01）.GDF-15与NT-proBNP对慢性心力衰竭的受试者工作特征曲线结果显示其下面积分别为0.804、0.795（P ＜0.01）.GDF-15的最佳临界值为1 086.38 ng/L时,对慢性心力衰竭诊断的敏感性为72.4％,特异性为93.6％.结论 GDF-15是一个新的冠心病患者慢性心力衰竭预后诊断标志物,能够对心力衰竭的严重程度进行客观评价.
Objective To explore the diagnostic value of the growth differentiation factor-15 （GDF-15） level in plasma and its relationship with chronic heart failure in coronary heart disease patients.Methods Totally 98 coronary heart disease patients with chronic heart failure（myocardial infarction group） or without chronic heart failure（coronary artery disease group） were enrolled in the study.Plasma GDF-15 level was determined with enzyme linked immunoadsorbent assay method and compared with 87 normal coronary artery disease patients （control group）.Results GDF-15 average level in myocardial infarction group,its various subgroups of cardiac function classification （New York Heart Association Ⅰ,Ⅱ,Ⅲ,Ⅳ） and coronary artery disease group were significant higher than those in control group[1 622（888,1 995）,983 （808,1 501）,1 614（810,1 825）,1 940（1 837,2 063）,3 905 （3 690,4 019）,945 （856,1 000） ng/L vs 798 （728,873） ng/L] （P 〈 0.05）.N-terminal pro-brain natriuretic peptide （NT-proBNP） average level in myocardial infarction group and its various subgroups of cardiac function classification （New York Heart Association Ⅰ,Ⅱ,Ⅲ,Ⅳ） were significant higher than control group [564 （158,857）,233 （105,552）,278 （133,716）,790 （636,1 490）,4 665 （3 712,5 442） ng/L vs 121 （108,134） ng/L] （P 〈0.05）.Mter adjustment,plasma GDF-15 level was found to be related to the proved clinical maker NT-proBNP （r =0.861,P 〈 0.01）,it was negative correlated with left ventricular ejection fraction（r =-0.936,P 〈 0.01）.The receiver operating characteristic curve of the GDF-15 level and NT-proBNP level was constructed and the area under concentration for continuous untransformed GDF-15 was 0.804,0.795 （P 〈 0.01）.Best critical value of GDF-15 was 1 086.38 ng/L,the diagnosis of chronic heart failure sensitivity was 72.4%,specificity was 93.6%.Conclusion GDF-15 can be used as a new prognostic biomarker of chronic heart failure.
出处
《中国医药》
2014年第2期149-153,共5页
China Medicine
