血清生长分化因子15与慢性心力衰竭患者的相关性研究

Association between serum growth differentiation factor-15 level and chronic heart failure

目的探讨血清生长分化因子15(GDF-15)与慢性心力衰竭(CHF)患者临床诊断及预后的相关性。方法选取因CHF在我院住院治疗的患者200例作为观察组;同期于本院体检中心选取健康人群100例作为对照组。记录受试者一般临床资料,心脏超声检查,检测GDF-15及N末端钠尿肽前体(NT-proBNP)水平。随访2年,记录观察组随访期间发生的心力衰竭相关不良事件。采用ROC曲线分析血清GDF-15水平对CHF的诊断价值及CHF预后的关系。结果观察组血清GDF-15水平明显高于对照组[1629.3(1250.1,2200.3)ng/L vs 839.7(725.0,880.5)ng/L,P<0.05];观察组血清GDF-15水平与NT-proBNP、心功能分级呈正相关性(r=0.682,0.326,P<0.05)。血清GDF-15和NT-proBNP诊断CHF的ROC曲线下面积分别是0.823和0.766,差异有统计学意义(P=0.00),两者联合AUC为0.829,两者联合优于GDF-15或NT-proBNP单一指标(P<0.05)。观察组随访期间不良事件发生率为49.0%,两者联合对CHF患者预后的预测价值优于单一指标(P<0.05)。结论血清GDF-15水平对CHF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 study the association of serum GDF-15 level with the diagnosis and outcome of chronic heart failure （CHF）. Methods Two hundred CHF patients served as an observa- tion group and 100 healthy subjects served as a control group in this study. Their general clinical data and biochemical parameters were recorded,their serum GDF-15 and NT-proBNP levels were measured. The patients were followed up for 2 years, during which HF-related adverse events were recorded. Association between the role of serum GDF-15 level in diagnosis of CHF and the outcome of CHF patients was analyzed according to the ROC curve. Results The serum GDF-15 level was significantly higher in observation group than in control group （1629.3 ng/L vs 839.7 ng/L,P〈0.05） and was positively associated with the serum NT-proBNP level and heart function in observation group （r=0. 682,r=0. 326,P〈0.05）. The area under the ROC curve for serum GDF-15 and NT-proBNP level in diagnosis of CHF was 0. 823 and 0. 766 respectively （P= 0.00）. The area under the ROC curve for combined GDF-15 and NT-proBNP was 0. 829, which was higher than that either for GDF 15 or for NT-proBNP （P〈0.05）. During the follow-up period,the incidence of adverse events was 49. 0% in observation group. The combined serum NT-proBNP and GDF-15 levels were significantly better than single serum GDF-15 or NT-proBNP level for the diagnosis of CHF （P〈0.05）. Conclusion Serum GDF-15 level plays a certain role in diagnosis of CHF and assessment of its outcome, and plays a greater role when it is used in combination with NT-proBNP.