血清TAFI和GDF-15在上消化道出血患者诊断及预后评估中的价值

Value of serum TAFI and GDF-15 in diagnosis and prognostic evaluation of patients with upper gastrointestinal hemorrhage

目的 探讨上消化道出血患者的血清纤溶抑制物(TAFI)、生长分化因子-15(GDF-15)表达水平及其在诊断及预后评估中的价值。方法 选择2020年5月至2023年6月保定市第二中心医院收治的94例上消化道出血患者设为研究组,根据AIMS65评分系统对患者预后的评估结果,将患者分为预后良好组(n=65)和预后不良组(n=29),另选择80名同期健康体检者设为对照组。收集入组患者的一般资料,采用ELISA法检测各组的血清TAFI、GDF-15水平,采用Spearman等级相关分析探讨上消化道出血患者的血清TAFI、GDF-15水平与AIMS65评分的相关性,采用ROC曲线分析血清TAFI、GDF-15对上消化道出血患者诊断和预后评估的价值。结果 研究组与对照组中有消化道出血史的患者占比差异有统计学意义(P<0.05);研究组的血清TAFI水平显著低于对照组,而血清GDF-15水平显著高于对照组(P均<0.05)。预后不良组的血清TAFI水平显著低于预后良好组,而血清GDF-15水平显著高于预后良好组(P均<0.05)。Spearman等级相关分析结果显示,上消化道出血患者的血清TAFI水平与AIMS65评分呈显著负相关,而血清GDF-15水平与AIMS65评分呈显著正相关(r=-0.493,r=0.537,P均<0.001)。ROC曲线分析结果显示,血清TAFI、GDF-15诊断上消化道出血的曲线下面积(AUC)分别为0.734和0.776,两者联合诊断的AUC为0.842,两者联合诊断上消化道出血的效能优于单独诊断(P均<0.05)。血清TAFI、GDF-15水平预测上消化道出血患者预后不良的AUC分别为0.658和0.712,两者联合预测上消化道出血患者预后不良的AUC为0.820,两者联合预测预后的效能优于单独预测(P均<0.05)。结论 TAFI在上消化道出血患者血清中呈低表达,而GDF-15呈高表达,两者与AIMS65评分均有相关性,两者联合检测对上消化道出血患者具有一定的诊断和预后预测价值。

Objective This paper aims to exploring the expression levels of serum thrombin activatable fibrinolysis inhibitor(TAFI)and growth differentiation factor-15(GDF-15)in patients with upper gastrointestinal bleeding and their value in diagnosis and prognosis evaluation.Methods Nintyfour patients with upper gastrointestinal bleeding admitted to Baoding Second Central Hospital from May 2020 to June 2023 were selected as the study group.According to the AIMS65 scoring system,the patients were assigned to the good prognosis group(n=65)and the poor prognosis group(n=29),and 80 healthy individuals who underwent physical examinations during the same period were selected as the control group.The general information of enrolled patients was collected,and the ELISA was used to detect serum TAFI and GDF-15 levels in each group.The Spearman rank correlation analysis was used to explore the correlation between serum TAFI and GDF-15 levels and AIMS65 score in patients with upper gastrointestinal bleeding.The ROC curve analysis was used to evaluate the diagnostic and prognostic value of serum TAFI and GDF-15 in patients with upper gastrointestinal bleeding.Results There is a statistically significant difference in the proportion of patients with a history of gastrointestinal bleeding between the study group and the control group(P<0.05).The serum TAFI level of the research group is significantly lower than that of the control group,while the serum GDF-15 level is significantly higher than that of the control group(P<0.05).The serum TAFI level in the poor prognosis group is significantly lower than that in the good prognosis group,while the serum GDF-15 level is significantly higher than that in the good prognosis group(P<0.05).The Spearman rank correlation analysis results show that the serum TAFI level of patients with upper gastrointestinal bleeding is significantly negatively correlated with the AIMS65 score,while the serum GDF-15 level is significantly positively correlated with the AIMS65 score(r=-0.493,r=0.537,and P<0.001).The ROC curve analysis results show that the area under the curve(AUC)of serum TAFI and GDF-15 for diagnosing upper gastrointestinal bleeding are 0.734 and 0.776,respectively.The AUC of the combined diagnosis of the two is 0.842,indicating that the combined diagnosis of the two is more effective than the individual diagnosis of upper gastrointestinal bleeding(P<0.05).The AUC of predicting poor prognosis in patients with upper gastrointestinal bleeding by serum TAFI and GDF-15 levels are 0.658 and 0.712,respectively.The AUC of predicting poor prognosis in patients with upper gastrointestinal bleeding by combining the two is 0.820,and the efficacy of predicting prognosis by combining the two is better than predicting it separately(P<0.05).Conclusions AFI shows a low expression in the serum of patients with upper gastrointestinal bleeding,while GDF-15 shows a high expression.Both are correlated with AIMS65 scores,and their combined detection has a certain diagnostic and prognostic value for patients with upper gastrointestinal bleeding.