血清生长分化因子-15与先天性心脏病患儿心功能的关系及其对心力衰竭的诊断价值

Plasma concentration of growth-differentiation factor-15 in children with congenital heart disease: relation ship to heart function and diagnostic value in heart failure

目的探讨生长分化因子-15(GDF-15)与先天性心脏病患儿心功能的关系及其对心力衰竭的诊断价值。方法 2011年3月至2012年5月成都市妇女儿童中心医院就诊的先天性心脏病患儿97例,依据改良Ross评分法分为心力衰竭组(71例)和无心力衰竭组(26例)。ELISA法检测两组血清GDF-15和B型脑钠肽前体(NT-proBNP)水平,超声心动图检测左室射血分数(LVEF)。采用Spearman相关分析对GDF-15与改良Ross评分、LVEF及NT-proBNP的相关关系进行分析。绘制ROC曲线并计算GDF-15曲线下面积及诊断心力衰竭的截断值。结果心力衰竭组患儿血清GDF-15和NT-proBNP水平较无心力衰竭组显著增高,LVEF明显降低,差异有统计学意义(P<0.01)。血清GDF-15水平与改良Ross评分及血清NT-proBNP水平呈正相关(分别r=0.705和0.810,P<0.01),与LVEF呈负相关(r=-0.421,P<0.01)。GDF-15诊断心力衰竭的ROC曲线下面积为0.757,当GDF-15的诊断界值为1306 ng/L,敏感性和特异性分别为68.8%和71.2%。结论先天性心脏病合并心力衰竭患儿血清GDF-15明显升高,血清GDF-15水平与先天性心脏病患儿心功能、LVEF及NT-proBNP水平均有不同程度的相关关系;GDF-15可能成为诊断小儿先天性心脏病合并心力衰竭的一项检测指标。

Objective To study the correlation between growth differentiation factor-15 （GDF-15） and cardiac function in pediatric patients with congenital heart disease, and the diagnositic value of GDF-15 in heart failure （HF）. Methods From March 2011 to May 2012, 97 pediatric patients with congenital heart disease （CHD） who consecutively attended Chengdu Women＇s ＆ Children＇s Central Hospital were enrolled in the study and assigned to HF （patients with heart failure, n =71 ） and Non-HF（patients without heart failure, n =26） groups. HF was defined as patients presenting with modified Ross score≥ 3. Plasma concentrations of GDF-15 and NT-proBNP were determined using ELISA. Left ventricular ejection fraction（LVEF） was tested by echocardiography. The correlation between GDF-15 and modified Ross score, LVEF and NT-proBNP was evaluated with Spearman＇s analysis. The area under the receiver-operating characteristic （ROC） curve for GDF-15 was examined, and the cut-off concentration of GDF-15 for diagnosing HF was detected. Results The HF group demonstrated higher levels of GDF-15 and NT-proBNP, and a lower LVEF level （P 〈 O. 01 ） than the Non- HF group. Plasma GDF-15 level was positively correlated with modified Ross score and plasma NT-proBNP comcentration （r =0. 705, r =0. 810 respectively; P 〈0.01 ）, and negatively correlated with LVEF（r = -0. 391, P 〈0.01 ）. According to ROC analysis, the AUC of GDF-15 for detection of HF was 0. 757. Sensitivity and specificity was 68.8% and 71.2% respectively for the cut-off value of 1306 ng/mL. Conclusions Plasma GDF-15 levels are significantly elevated in children with HF induced by CHD. Plasma GDF-15 levels are related to cardiac function, LVEF and plasma concentration of NTproBNP. GDF-15 may potentially indicate HF in pediatric patients with CHD.