GDF-15在左心室射血分数正常心力衰竭患者诊疗中的应用价值

Significance of serum GDF-15 in the diagnosis and prognostic prediction of heart failure with preserved ejection fraction

目的探讨血清生长分子因子-15(GDF-15)在左心室射血分数(LVEF)正常心力衰竭(HF-PEF)患者诊断和预后预测中的意义。方法选择HF-PEF患者62例(HF-PEF组),L.VEF减低心力衰竭68例(HF-REF组),健康者40例,测定血清GDF-15、NT-proBNP水平、LVEF和左心室舒张末期内径;HF-PEF、HF-REF组给予常规治疗并随访2年,记录心力衰竭相关不良事件。结果 HF-PEF组血清GDF-15水平高于对照组,低于HF-REF组,差异均有统计学意义(均P<0.01)。血清GDF-15和NT-proBNP诊断HF-PEF的ROC曲线下面积(AUC)分别为0.814和0.764,差异有统计学意义(P<0.05);两者联合诊断的AUC为0.829,优于GDF-15或NT-proBNP单一指标(均P<0.05)。血清GDF-15和NT-proBNP预测HF-PEF心力衰竭相关不良事件的AUC分别为0.825和0.805,差异无统计学意义(P>0.05);两者联合预测AUC为0.832,优于NT-proBNP单一指标(P<0.05)。结论血清GDF-15水平对HF-PEF诊断及预后评估有一定的价值,与NT-proBNP联合应用价值更高。

Objective To explore the value of serum growth differentiation factor- 15 （GDF- 15） in the diagnosis and prognostic prediction of heart failure （HF） with preserved ejection fraction （HF- PEF）. Methods 62 patients with HFPEF, 68 patients with HF and a reduced ejection fraction （HF- REF） and 40 healthy subjects were enrolled. Serum GDF- 15 and NT- proBNP concentration, left ventricular ejection fraction, left ventricular end diastolic dimension were measured. HF- PEF and HF- REF patients received conventional treatment and were followed up for 2 years. Results Serum GDF- 15 in HF- PEF patients was significantly higher than that in healthy subjects （P〈0.01） and lower than that in HF- REF patients （P〈0.01）. The area under the receiver operating characteristic curve （AUC） for diagnosis of HFPEF was 0.814 for GDF- 15, significantly higher than 0.764 for NT- proBNP（P〈0.05）. AUC of GDF- 15 combined with NT- proBNP was 0.829, higher than either one alone （P〈0.05）. AUC for prediction of HF- related adverse events was 0.825 for GDF- 15 and 0.805 for NT- proBNP, which was 0.832 for GDF- 15 combined NT- proBNP and significantly higher than either of them （P〈0.05）. Conclusion Serum GDF- 15 is helpful in the diagnosis and prognostic prediction of HF- PEF, especial y when combined with NT- proBNP.