生长分化因子-15与N末端-B型利钠肽原及超敏C反应蛋白在急性心力衰竭中的诊断价值

The diagnostic value of growth differentiation factor-15 and N-terminal B-type natriuretic peptide prosoma and high-sensitivity C-reactive pro-tein in patients with acute heart failure

目的探讨血清生长分化因子-15(GDF-15)与N末端B型利钠肽原(NT-proBNP)及全血超敏C反应蛋白(hs-CRP)在不同严重程度急性心力衰竭(AHF)患者中的表达水平及诊断价值。方法选取吉林省延边第二人民医院急诊科于2014年4月~2016年4月收治的AHF患者77例(心衰组)及健康体检者60例(对照组)。采用ELISA法检测血清GDF-15、NT-proBNP,免疫层析法检测全血hs-CRP水平,常规做心电图和超声心动图检查左心室射血分数(LVEF)及胸部X线检查,分析GDF-15、NT-proBNP和hs-CRP的表达水平以及三者之间的相关性。结果与对照组比较,心衰组的GDF-15、NT-proBNP和hs-CRP的水平明显升高,左室射血分数(LVEF)明显降低,差异有统计学意义(P<0.05);临床程度Ⅰ~Ⅳ级患者NT-proBNP、hs-CRP水平有升高趋势,差异无统计学意义(P>0.05);GDF-15、hs-CRP与NT-proBNP水平呈正相关,hs-CRP与NT-proBNP呈正相关,LVEF、GDF-15与NT-pro BNP呈负相关(P<0.01);ROC曲线分析显示NT-proBNP、GDF-15、hs-CRP的曲线下面积对AHF的诊断比较,差异有统计学意义(P<0.05),诊断能力NT-proBNP>GDF-15>hs-CRP。结论血清GDF-15、NT-proBNP、全血hs-CRP水平在AHF中明显升高,且随着临床严重程度增加而升高。血清GDF-15可以作为AHF患者诊断、治疗、判断预后的又一新指标,其联合NT-proBNP和hs-CRP检测对AHF的诊治、危险分层、预后判断意义更大。

Objective To explore the expression level and diagnostic value of serum growth differentiation factor-15（GDF-15）, N-terminal B-type natriuretic peptide prosoma（NT-pro BNP） and high-sensitivity C-reactive protein（CRP）in patients with acute heart failure（AHF） and patients with different severity of AHF. Methods A total of 77 patients with AHF（AHF group） and 60 cases of healthy examined people（control group） from April 2014 to April 2016 in the Second Hospital of Yanbian were selected. The expression level of serum GDF-15 and NT-pro BNP were detected by ELISA, the expression of hs-CRP was detected by immunochromatography, routine electrocardiogram and echocardiography were performed to examine the left ventricular ejection fraction（LVEF） and chest X-ray examination. The correlation between GDF-15, NT-pro BNP, hs-CRP expression level and the three factors were analyzed. Results Compared with the control group, the expression of GDF-15, NT-pro BNP and hs-CRP were significantly increased and the left ventricular ejection fraction（LVEF） was significantly reduced in AHF group, the difference was statistically significant（P〈0.05）. The levels of NT-pro BNP, hs-CRP among clinical grades Ⅰto Ⅳ had increased trend, the difference was not statistically significant（P〈0.05）. GDF-15 and hs-CRP were positively correlated to NT-pro BNP, hs-CRP was positivly correlated to NT-pro BNP, LVEF and GDF-15 were negatively correlated to NT-pro BNP（P〈0.01）. The ROC curve analysis showed that the areas under the curve of NT-pro BNP, GDF-15 and hs-CRP had statistical significance in diagnosing AHF（P〈0.05）, the diagnostic ability was NT-pro BNP GDF-15 hs-CRP. Conclusion The serum levels of GDF-15, NT-pro BNP and hs-CRP are significantly elevated in patients with AHF, and increasd as the clinical severity. The serum GDF-15 can be used as a new index for diagnosis, treatment and estimating prognosis of patients with AHF. GDF-15 combined with the detection of NT-pro BNP and hs-CRP has great significance in diagnosing and treating, distinguishing risk stratification and judging prognosis AHF.