生长分化因子15和高敏C反应蛋白对冠状动脉旁路移植术后患者发生心房颤动的预测价值

Prognostic value of growth differentiation factor-15 and high sensitive C-reactive protein on atrial fibrillation in patients after coronary artery bypass grafting

目的探究生长分化因子15(GDF-15)和高敏C反应蛋白(hs-CRP)水平对冠状动脉旁路移植(CABG)术后患者发生心房颤动的预测价值。方法选取2018年10—12月于首都医科大学附属北京安贞医院行CABG患者84例,根据术后是否发生心房颤动将其分为心房颤动组(22例)和非心房颤动组(62例)。比较2组患者的一般资料、CABG术前血清GDF-15和hs-CRP水平。采用单因素和多因素Logistic回归方法分析GDF-15、hs-CRP水平与术后发生心房颤动的关系。采用受试者工作特征曲线分析GDF-15和hs-CRP对CABG术后患者发生心房颤动的预测效能。结果CABG术前,心房颤动组心力衰竭比例、血清GDF-15和hs-CRP水平均高于非心房颤动组[59.1%(13/22)比25.8%(16/62)、98.2(75.3,137.2)ng/L比74.9(56.4,95.8)ng/L、4.4(0.9,9.2)mg/L比1.2(0.5,2.8)mg/L],差异均有统计学意义(均P<0.05)。单因素Logistic回归分析显示,CABG术前GDF-15和hs-CRP水平升高是术后发生心房颤动的危险因素;校正心力衰竭后,多因素Logistic回归分析显示CABG术前GDF-15和hs-CRP水平升高是术后发生心房颤动的危险因素(均P<0.05)。GDF-15、hs-CRP及二者联合预测CABG术后发生心房颤动的曲线下面积为0.705(95%置信区间:0.577~0.833,P=0.005)、0.677(95%置信区间:0.540~0.814,P=0.013)、0.740(95%置信区间:0.612~0.869,P=0.001)。以hs-CRP为参照,GDF-15联合hs-CRP预测CABG术后心房颤动的重分类改善指数为0.516(95%置信区间:0.047~0.985,P=0.031)、综合判别改善指数为0.080(95%置信区间:0.007~0.153,P=0.031)。结论CABG术前血清GDF-15和hs-CRP水平对术后心房颤动的发生具有一定预测价值,二者联合预测效能高于hs-CRP单独预测,但与GDF-15单独预测相比,其预测效能未得到显著改善。

Objective To investigate the prognostic value of growth differentiation factor-15(GDF-15)and high sensitive C-reactive protein(hs-CRP)on atrial fibrillation(AF)in patients after coronary artery bypass grafting(CABG).Methods Totally 84 patients who underwent CABG in Beijing Anzhen Hospital,Capital Medical University from October to December 2018 were enrolled.According to the occurrence of AF after CABG,the patients were divided into AF group(22 cases)and non-AF group(62 cases).The general data and levels of GDF-15 and hs-CRP before CABG were compared between the two groups.Univariate and multivariate Logistic regression analysis were used to analyze the relationship between the levels of GDF-15,hs-CRP and occurrence of AF in patients after CABG.Receiver operating characteristic curve was used to analyze the prognostic efficiency of GDF-15 and hs-CRP on occurrence of AF in patients after CABG.Results Before CABG,the rate of heart failure,levels of GDF-15 and hs-CRP in AF group were higher than those in non-AF group[59.1%(13/22)vs25.8%(16/62),98.2(75.3,137.2)ng/L vs 74.9(56.4,95.8)ng/L,4.4(0.9,9.2)mg/L vs 1.2(0.5,2.8)mg/L](all P<0.05).Univariate Logistic regression analysis showed that the elevated levels of GDF-15 and hs-CRP were the risk factors of AF in patients after CABG.After adjustment for heart failure,multivariate Logistic regression analysis showed that the elevated levels of GDF-15 and hs-CRP were independent risk factors of AF in patients after CABG(all P<0.05).Areas under curve of GDF-15,hs-CRP and their combination in predicting AF in patients after CABG were 0.705[95%confidence interval(CI):0.577-0.833,P=0.005],0.677(95%CI:0.540-0.814,P=0.013),0.740(95%CI:0.612-0.869,P=0.001).Compared with hs-CRP,the net reclassification improvement of GDF-15 combined with hs-CRP in predicting AF in patients after CABG was 0.516(95%CI:0.047-0.985,P=0.031)and the comprehensive discriminant improvement index was 0.080(95%CI:0.007-0.153,P=0.031).Conclusions The serum levels of GDF-15 and hs-CRP before CABG have certain predictive value for the occurrence of AF in patients after CABG.The combined predictive efficacy of GDF-15 and hs-CRP is higher than that of hs-CRP alone,but it is similar to that of GDF-15 alone.