血清生长分化因子-15、SYNTAX评分在急性冠脉综合征中的相关性及对患者心血管事件的作用和机制研究

Correlation and mechanisms of serum growth differentiation factor-15 and syntax score in patients with acute coronary syndrome and their effects on cardiovascular events

目的探讨生长化因子-15(GDF-15)与SYNTAX评分在非ST段抬高急性冠脉综合征(NSTEACS)患者两年随访时主要心血管不良事件(MACE)风险预测中的相关性,并探讨可能的调节机制。方法随机选取104例NSTEACS患者进行前瞻性队列研究;根据冠脉造影结果计算基线SYNTAX评分,采用ELISA方法检测血清GDF-15和白介素-1β(IL-1β)的表达,分析其与主要心血管不良事件(MACE)风险的相关性;并检测不同GDF-15表达组中TGF-RI/Smad的mRNA表达。结果随访2年,31例(29.81%)出现MACE。发生MACE的患者GDF-15浓度、IL-1β和SYNTAX评分高于未发生MACE的患者(P<0.05)。GDF-15与SYNTAX得分呈正相关(r=0.41,P<0.05)。在COX回归分析中,只有GDF-15水平(P<0.05)、IL-1β(P<0.05)和语法评分(P<0.05)是MACE的独立预测因子。GDF-15曲线下面积显著高于IL-1β和SYNTAX评分(P<0.05)。GDF-15高表达组和中表达组TGF-βRI、Smad2、Smad3的mRNA表达明显高于GDF-15低表达组(P<0.05),GDF-15高表达组TGF-βRI、Smad2、Smad3的mRNA表达明显高于中表达组(P<0.05)。结论NSTEACS患者入院时GDF-15水平与SYNTAX评分相关,并且在2年随访期间与MACE风险增加独立相关,可能通过调节TGF-βRI/Smad信号发挥作用。

Objective To investigate the correlation both GDF-15 and the SYNTAX score on predicting major cardiovascular adverse events(MACE)in patients with non-ST segment elevation acute coronary syndrome(NSTEACS)at two-year follow-up,and to explore the possible regulatory mechanism.Methods104 patients with NSTEACS were randomly selected for prospective cohort study.The baseline SYNTAX score was calculated according to the results of coronary angiography.Blood samples were collected at the beginning of the study.The serum concentration of GDF-15,and IL-1βwere detected by ELISA.The correlation between GDF-15 and the risk of major cardiovascular adverse events(MACE)was analyzed.The mRNA levels of TGF-βRI/Smad pathway was detected in different GDF-15 expression groups.ResultsAfter two years of following-up,31 cases(29.81%)had MACE.The levels of GDF-15,IL-1βand syntax score in patients with MACE were higher than those in patients without MACE(P<0.05).GDF-15 was positively correlated with syntax score(r=0.41,P<0.05).In Cox regression analysis,only GDF-15 level(P<0.05),IL-1β(P<0.05)and grammar score(P<0.05)were independent predictors of MACE.The area under GDF-15 curve was significantly higher than that of IL-1βand syntax(P<0.05).The mRNA expression of TGF-βRI,Smad2 and Smad3 in GDF-15 high expression group and middle expression group was significantly higher than that in GDF-15 low expression group(P<0.05).The mRNA expression of TGF-βRI,Smad2 and Smad3 in GDF-15 high expression group was significantly higher than that in middle expression group(P<0.05).ConclusionGDF-15 level at admission is related to syntax score,and it is independently related to increased mace risk during two years of following-up,and it may be effected by regulating TGF-βRI/Smad signal.