生长分化因子-15及N端脑利钠肽原对儿童先天性心脏病并心力衰竭的诊断价值

Diagnostic value of growth differentiation factor-15 and N-terminal pro-brain natriuretic peptide in children with congenital heart disease complicated with heart failure

目的探讨生长分化因子-15（GDF-15）及N端脑利钠肽原（NT—proBNP）对儿童先天性心脏病并心力衰竭的诊断价值。方法收集2011年1月至2012年12在新疆医科大学第一附属医院住院的先天性心脏病患儿206例为病例组，选择同期住院的无先天性心脏病及无心力衰竭儿童105例为对照组。以改良Ross评分≥3分作为心力衰竭参考标准，将病例组患儿分为无心力衰竭组（0～2分，112例）和心力衰竭组（3～12分，94例）；心力衰竭组又分为轻度心力衰竭组（3—6分，38例）、中度心力衰竭组（7～9分，32例）和重度心力衰竭组（10～12分，24例）。测定其血浆NT—proBNP、GDF-15水平，同时使用超声心动图测定其左心室射血分数（LVEF）。血浆GDF-15、NT-proBNP水平分别与Ross评分心功能分级及LVEF行直线相关分析。制作受试者工作特征曲线（ROC）判定诊断临界点或阈值，评估血浆GDF-15、NT-proBNP水平对先天性心脏病并心力衰竭的诊断价值。结果病例组和对照组年龄、性别比较差异无统计学意义（x2=4．233、4．360，P均〉0．05）。心力衰竭组血浆LogGDF．15及LogNT—proBNP水平明显高于无心力衰竭组和对照组（F=115．2、63．2，P均〈0．01）。血浆GDF-15、NT-proBNP水平均随心力衰竭程度加重而升高，与改良Ross评分呈明显正相关（r=0．890，P〈0．01）。与LVEF呈负相关（r=-0．652，P〈0．01）。GDF-15与NT-proBNP并联，即当血浆GDF-15≥831．6ng／L与NT—proBNP≥759．8ng／L同时存在时诊断心力衰竭的特异度（80．2％）和敏感度（77．9％）。结论血浆GDF-15及NT-proBNP对小儿先天性心脏病导致的心力衰竭具有诊断价值，二者升高水平与临床心力衰竭程度关系密切，二者联合检测可提高特异度及敏感度。

Objective To assess the values of growth differentiation factor-15 （GDF-15） and N-terminal pro- brain natriuretie peptide （NT-proBNP） for the diagnosis of children with congenital heart disease （ CHD ） combined with heart failure. Methods Among the children under treatment at the First Affiliated Hospital of Xinjiang Medical University from Jan. 2011 to Dec. 2012,206 children those suffered with CHD were selected as the ease group. One hundred and five children without CHD or heart failure were selected as the control group. Improved Ross score ≥3 grades was taken as reference standard for heart failure. The case group was divided into non-heart failure group （0 -2 grades, 112 cases） and the heart failure group （3 - 12 grades,94 cases）. The heart failure group was divided into mild heart failure group （ 3 - 6 grades,38 cases ） , moderate heart failure group （ 7 - 9 grades, 32 cases） and severe heart failure group （10 -12 grades,24 cases）. Levels of plasma GDF-15 and NT-proBNP were tested. In the meanwhile, the left ventricular ejection fraction （LVEF） was tested with ultrasonic cardiogram. Linear correlation analysis was performed for evaluating levels of plasma GDF-15 and NT-proBNP against the cardiac function grading in Ross scores and the LVEF, respectively. ROC curve was made to determine critical point or threshold value of diagnosis and assess values of levels of plasma GDF-15 and NT-proBNP for diagnosis of congenital heart disease combined with heart failure. Results Comparison of age and gender differences between the case group and the control group showed no statistically sigmficant（x2 = 4. 233,4. 360, P 〉 0.05 ）. Levels of plasma LogGDF-15 and LogNT-proBNP in the heart failure group were significantly higher than those values of the non-heart failure group and the control group（ F = 115.2,63.2, all P 〈 0. 01 ）. Levels of plasma GDF-15 and NT-proBNP increased with the severity of heart failure and were positively correlated with improved Ross scores （ r = 0. 890, P 〈 0.01 ） and negatively correlated with LVEF （ r = - 0. 652, P 〈 0. 01 ）. GDF-15 was considered in combination with NT-proBNP, the specificity （80.2%） and precision （77.9%） for diagnosis of heart failure could be enhanced when plasma GDF-15 ≥831.6 ng/L coexisted with NT-proBNP ≥759.8 ng/L. Conclusions Plasma GDF-15 and NT-proBNP can help the diagnosis of heart failure caused by CHD in children. The increase of these two factors is closely related to the severity of clinical heart failure. Combination of these two factors for test can enhance specificity and precision for diagnosis of heart failure.