GDF-15对比NT-proBNP评估沙库巴曲缬沙坦治疗慢性心力衰竭患者预后的作用

Comparison of GDF-15 and NT-proBNP to evaluate the prognosis of sacubitril/valsartan on patients with chronic heart failure

目的 探讨慢性心力衰竭患者在沙库巴曲缬沙坦治疗过程中生长分化因子15(GDF-15)的表达差异与其临床预后的关系.方法 选取2019年2月—12月于徐州医科大学附属医院住院期间病情得到稳定控制的慢性心力衰竭患者作为研究对象,共计84例.所有患者入院后在常规治疗基础上均予以沙库巴曲缬沙坦口服治疗,出院后连续治疗12周.根据患者出院后90 d内是否发生心力衰竭再住院或全因死亡事件,将患者分为无事件组(n=68)、事件组(n=16).分别测定患者在出院时、出院12周随访复查或期间因心力衰竭再住院时GDF-15、氨基末端B型利钠肽(NT-proBNP)的水平.记录患者出院12周内发生心力衰竭再住院或全因死亡的结果 .采用ROC曲线评估不同时间节点GDF-15和NT-proBNP水平预测心力衰竭患者短期发生不良预后的效能.结果事件组患者出院时GDF-15水平、出院12周时GDF-15和NT-proBNP水平显著高于无事件组患者(P<0.05);事件组和无事件组患者出院时NT-proBNP水平比较,差异无统计学意义(P>0.05).事件组患者出院12周GDF-15和NT-proBNP水平明显高于出院时,无事件组患者出院12周GDF-15和NT-proBNP水平明显低于出院时(P<0.05).出院时GDF-15水平预测心力衰竭再住院及死亡事件的AUC=0.865,最佳截断值3357 ng/L,敏感度为81.3%,特异度为82.4%.结论 血浆GDF-15变化水平与慢性心力衰竭患者出院后早期发生心力衰竭再住院及病死率相关,其中出院时血浆GDF-15水平对慢性心力衰竭患者的不良预后具有一定预测价值.

Objective To investigate the relationship between the expression of growth differentiation factor 15(GDF-15)in patients with chronic heart failure treated with sacubatril/valsartan and its clinical prognosis.Methods A total of 84 patients with chronic heart failure whose conditions were under stable control during their hospitalization in the Affiliated Hospital of Xuzhou Medical University from February to December 2019 were selected.All patients were given oral sacubatril/valsartan on the basis of routine treatment after admission,and received consecutive treatment for 12 weeks after discharge.According to the presence of heart failure re-admission or all-cause death within 90 d after discharge,the patients were divided into two groups:an event-free group(n=68)and an event group(n=16).The levels of GDF-15 and N-terminal pro-B-type natriuretic peptide(NT-proBNP)were measured when the patients were discharged,during 12-week follow-up or during re-hospitalization for heart failure.The outcomes of heart failure re-hospitalization or all-cause death were recorded within 12 weeks after discharge.The ROC curve was plotted to evaluate the efficacy of GDF-15 and NT-proBNP levels at different time points to predict the adverse prognosis of heart failure patients in a short term.Results Patients in the event group produced remarkably a higher GDF-15 level at discharge,and higher GDF-15 and NT-proBNP levels 12 weeks after discharge than those in the non-event group(P<0.05).There was no statistical difference in the level of NT-proBNP at discharge between the event group and the non-event group(P>0.05).Patients in the event group produced remarkably higher levels of GDF-15 and NT-proBNP 12 weeks after discharge than those after discharge,while the levels of GDF-15 and NT-proBNP in the non-event group were markedly lower 12 weeks after discharge in the non-event group than those after discharge(P<0.05).According to GDF-15 level at discharge,the predicted AUC=0.865 for heart failure re-admission and death,with an optimal cut-off value of 3357 ng/L,a sensitivity of 81.3%,and a specificity of 82.4%.Conclusions The level of plasma GDF-15 is correlated with early re-hospitalization and mortality of patients with chronic heart failure after discharge,where plasma GDF-15 level at discharge shows certain predictive value for adverse prognosis of patients with chronic heart failure.