摘要
目的探讨生长转化因子15(GDF-15)、可溶性肿瘤形成抑制素2(ST-2)、N端脑钠肽前体(NT-proBNP)在左室射血分数保留或降低的心力衰竭(心衰)患者中的表达差异性以及其临床应用价值。方法选取2016年2月至2018年2月于香港大学深圳医院心内科就诊的心衰患者267例为研究对象,依据入院时超声心动图检查结果分组。其中,左室射血分数保留的心衰(HFp EF)患者为HFp EF组(n=118),左室射血分数降低的心衰(HFr EF)患者为HFr EF组(n=149)。测定两组患者实验室生化指标血糖、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、糖化血红蛋白(HbA1C);ELISA试剂盒测定患者血浆中GDF-15和ST-2含量;采用电化学发光法测定血液标本中NT-proBNP水平;心脏彩色多普勒超声检查记录心功能指标左心室射血分数(LVEF)、左心房内径(LAD)、左心室舒张末期内径(LVDd)、二尖瓣血流E峰和A峰流速比值(MVE/MVA)等;并采用受试者工作特征(ROC)曲线分析GDF-15、ST-2、NT-proBNP对HFp EF的诊断价值。结果①入院时,两组患者血糖和血脂指标相比,差异均无统计学意义(P均>0.05);HFp EF组患者外周血GDF-15、ST-2、NT-proBNP水平均低于HFr EF组患者,差异有统计学意义(P<0.05)。②HFp EF组患者LVEF高于HFr EF组患者,而其他心功能指标均低于HF-REF组患者,差异均具有统计学意义(P<0.05)。③经多因素Logistic回归分析,年龄、性别、GDF-15、ST-2、NT-proBNP和LVEF是HFp EF发生的独立影响因素(P<0.05)。④经ROC曲线分析,GDF-15、ST-2、NT-proBNP联合诊断的ROC曲线下的面积以及敏感度和特异度明显高于单独诊断指标(χ2=11.355,P<0.05)。结论外周血GDF-15、ST-2、NT-proBNP水平与LVEF密切相关,可作为HFp EF患者的预测因子。
Objective To discuss the expressions and clinical value of growth differentiation factor-15(GDF-15),suppression of tumorigenicity-2(ST-2)and N-terminal pro-brain natriuretic peptide(NT-proBNP)in patients with heart failure with preserved ejection fraction(HF p EF)or heart failure with reduced ejection fraction(HF r EF).Methods The patients(n=267)were chosen from Kong from Feb.2016 to Feb.2018.All patients were divided,according to results of echocardiogram at hospitalization time,into HF p EF group(n=118)and HF-REF group(n=149).The levels of blood sugar,total cholesterol(TC),triglyceride(TG),high-density lipoprotein-cholesterol(HDL-C),low-density lipoprotein-cholesterol(LDL-C)and glycated hemoglobin(HbAlc)were detected in 2 groups.The content of GDF-15 and ST-2 were detected by using ELISA,and level of NT-proBNP was detected by using electro-chemiluminescence immunoassay(ECLIA).The left ventricular ejection fraction(LVEF),left atrial diameter(LAD),left ventricular end-diastolic inner diameter(LVEDd)and peak E mitral blood flow velocity/peak A mitral blood flow velocity(MVE/MVA)were recorded by using color Doppler ultrasonography.The diagnostic value of GDF-15,ST-2 and NT-proBNP to HF p EF was analyzed by using receiver operating characteristic(ROC)curve.Results①The difference in indexes of blood sugar and blood fat had no statistical significance between 2 groups(all P >0.05)at hospitalization time.The levels of GDF-15,ST-2 and NT-proBNP were lower in HF p EF group than those in HF r EF group(P<0.05).②LVEF was higher and other heart function indexes were lower in HF p EF group than those in HF r EF group(P<0.05).③The results of multi-factor Logistic regression analysis showed that age,sex,GDF-15,ST-2,NT-proBNP and LVEF were independent impacting factors of(P<0.05).④The results of ROC curve analysis showed that the area under ROC curve,sensitivity and specificity of integrated GDF-15,ST-2 and NT-proBNP in diagnosis were significantly higher than those of single diagnostic index(χ^2=11.355,P<0.05).Conclusion The levels of GDF-15,ST-2 and NT-proBNP are closely correlated to LVEF,and they can be used as predictive factors in HF p EF patients.
作者
汪润
曹高镇
林庆陕
Wang Run;Cao Gaozhen;Lin Qingshan(Department of Cardiology,Shenzhen Hospital,University of Hong Kong,Shenzhen 518000,China)
出处
《中国循证心血管医学杂志》
2019年第1期67-70,74,共5页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
深圳市科技计划项目(JCYJ20150331142757380)
关键词
生长转化因子15
可溶性肿瘤形成抑制素2
N端脑钠肽前体
心力衰竭
预测指标
Growth differentiation factor-15
Suppression of tumorigenicity-2
N-terminal pro-brain natriuretic peptide
Heart failure
Predictive indexes
