GDF-15、NT-proBNP与急诊就诊时血压心率在急性心力衰竭患者诊断中的临床研究

Clinical Study of GDF-15,NT-proBNP and Blood Pressure Heart Rate in Emergency Diagnosis of Acute Heart Failure

目的:探讨血清生长分化因子-15(GDF-15)、N末端-B型利钠肽原(NT-proBNP)与就诊时血压、心率在急性心力衰竭患者诊断中的临床意义。方法:选取急性心力衰竭患者77例(急性心衰组),健康体检者60例(对照组);急性心衰组分为临床程度分级Ⅰ级14例,Ⅱ级22例,Ⅲ级22例,Ⅳ级19例。采用ELISA法检测血清GDF-15、NT-proBNP,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与患者就诊时血压、心率之间的相关性。结果:与对照组相比较,急性心衰组的GDF-15、NT-proBNP、收缩压(SBP)、舒张压(DBP)、心率明显升高,差异均有统计学意义(P<0.05);急性心衰组左室射血分数(LVEF)明显降低,差异有统计学意义(P<0.05)。急性心衰组临床程度Ⅰ~Ⅳ级组GDF-15、收缩压、舒张压、心率依次升高,差异均有统计学意义(P<0.05),GDF-15、SBP、DBP、心率与NT-proBNP水平呈线性正相关(r=0.723、0.273、0.210、0.474,P<0.05)。结论:急性心力衰竭患者就诊时的血压、心率可以作为急性心衰患者危险分层、判断预后、选择治疗方案的指标,并且简单易取得,与GDF-15、NT-proBNP联合分析则更具有准确性。

Objective:To investigate the clinical significance of serum growth differentiation factor-15(GDF-15),N-terminal B-type natriuretic peptide(NT-proBNP),blood pressure and heart rate in the diagnosis of acute heart failure.Method:77 patients with acute heart failure(acute heart failure group)and 60 healthy subjects(control group)were selected,the patients of acute heart failure were divided into clinical gradeⅠ(n=14),gradeⅡ(n=22),gradeⅢ(n=22)and gradeⅣ(n=19).Serum GDF-15 and NTproBNP were measured by ELISA.Left ventricular ejection fraction(LVEF)and chest X-ray were examined by electrocardiogram(ECG)and echocardiography.The correlation of GDF-15 and NT-proBNP with blood pressure and heart rate at the time of patients’visit were analyzed.Result:Compared with the control group,the levels of GDF-15,NT-proBNP,systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate were significantly higher in the acute heart failure group,the differences were statistically significant(P<0.05).The LVEF in acute heart failure group was significantly lower than that of control group(P<0.05).GDF-15,systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)increased in turn in patients with acute heart failure(gradeⅠ-Ⅳ),the differences were statistically significant(P<0.05);the GDF-15,SBP,DBP and heart rate was positively correlated with NT-proBNP(r=0.723,0.273,0.210,0.474;P<0.05).Conclusion:The blood pressure and heart rate of patients with acute heart failure can be used as indicators of risk stratification,prognosis and treatment options in patients with acute heart failure,it is easy to obtain,the joint analysis with GDF-15 and NT-proBNP is more accurate.