血清GDF-15和Lp-PLA2在慢性心衰不同NYHA分级中的变化及与心室重构的关系探讨

Changes of serum GDF-15 and Lp-PLA2 in different NYHA classification of chronic heart failure and relationship between them and ventricular remodeling

目的探讨血清生长分化因子15(GDF-15)和脂蛋白相关磷脂酶A2(Lp-PLA2)在慢性心衰(CHF)美国纽约心脏病协会(NYHA)心功能不同分级中的变化,并分析其与心室重构的关系。方法选取2015年1月至2018年1月于洛阳市第三人民医院心内科收治的80例CHF患者(心衰组)和40例健康体检者(对照组)作为研究对象,采用酶联免疫吸附试验(ELISA)检测血清GDF-15和Lp-PLA2水平,采用超声心动图检测心脏相关指标,左心房内径(LAD)、左心室舒张末内径(LVEDD)、右心室内径(RVD)、室间隔厚度(IVST)、左心室后壁舒张末期厚度(LVPWTd)和左心室射血分数(LVEF),左心室质量指数(LVMI),左心室质量(LVM)以及主要不良心血管事件(MACE),随访截止日期为2019年6月。结果心衰组血清GDF-15和Lp-PLA2分别为(179.56±28.46)ng/L和(205.33±24.42)mg/L,对照组血清GDF-15和Lp-PLA2分别为(84.77±12.59)ng/L和(35.58±6.74)mg/L,两组比较差异有统计学意义(P<0.05)。绘制ROC曲线分析发现,血清GDF-15和Lp-PLA2对CHF均有一定诊断价值(P<0.05),两者联合诊断效能最高(P<0.05);血清GDF-15和Lp-PLA2对CHF-MACE均有一定预测价值(P<0.05),两者联合预测效能最高(P<0.05)。血清GDF-15和Lp-PLA2在NYHAⅠ级、Ⅱ级、Ⅲ级和Ⅳ级中依次升高,比较差异有统计学意义(P<0.05)。经Pearson相关分析,血清GDF-15和Lp-PLA2与LAD、LVEDD、RVD、LVPWD、IVST和LVMI呈正相关(P<0.05),与LVEF呈负相关(P<0.05)。经Logistic回归模型分析,血清GDF-15和Lp-PLA2均是影响CHF-MACE的独立因素(P<0.05)。结论血清GDF-15和Lp-PLA2有望成为CHF诊断和CHF-MACE预测的有效指标,与NYHA心功能分级和心室重构密切相关。

Objective To investigate the changes of serum growth differentiation factor-15(GDF-15)and lipoprotein associated phospholipase A2(Lp-PLA2)in different NYHA classes of chronic heart failure(CHF),and analysis the relationship between these change and ventricular remodeling.Methods CHF patients(n=80,CHF group)and healthy controls(n=40,control group)were chosen from Department of Cardiology in the Third People’s Hospital of Luoyang City from Jan.2015 to Jan.2018.The levels of serum GDF-15 and Lp-PLA2 were detected by using enzyme linked immunosorbent assay(ELISA).The heart-related indexes were detected by using echocardiogram,including left atrial diameter(LAD),left ventricular end-diastolic inner diameter(LVEDD),right ventricular diameter(RVD),interventricular septal thickness(IVST),left ventricular posterior wall thickness at end diastole(LVPWTd),left ventricular ejection fraction(LVEF),left ventricular mass index(LVMI)and left ventricular mass(LVM).The incidence of major adverse cardiovascular events(MACE)was followed up and deadline was June 2019.Results The level of serum GDF-15 was(179.56±28.46)ng/L and level of Lp-PLA2 was(205.33±24.42)mg/L in CHF group,and level of GDF-15 was(84.77±12.59)ng/L and level of Lp-PLA2 was(35.58±6.74)mg/L in control group(P<0.05).The ROC curve showed that the levels of serum GDF-15 and Lp-PLA2 all had diagnostic value to CHF(P<0.05),and combination of them had higher diagnostic efficacy(P<0.05).The levels of serum GDF-15 and Lp-PLA2 all had diagnostic value to CHF-MACE(P<0.05),and combination of them had higher diagnostic efficacy(P<0.05).The levels of serum GDF-15 and Lp-PLA2 increased successively in NYHA classesⅠ,Ⅱ,ⅢandⅣ(P<0.05).The results of Pearson correlation analysis showed that the levels of serum GDF-15 and Lp-PLA2 were positively correlated to LAD,LVEDD,RVD,LVPWD,IVST and LVMI(P<0.05),and negatively correlated to LVEF(P<0.05).The results of Logistic regression model analysis showed that the levels of serum GDF-15 and Lp-PLA2 all were independent factors influencing CHF-MACE(P<0.05).Conclusion The levels of serum GDF-15 and Lp-PLA2 are expected to be effective indexes for CHF diagnosis and CHF-MACE prediction,and they are closely correlated to NYHA classification and ventricular remodeling.