生长分化因子15和B型利钠肽对心力衰竭患者心血管结局的预测价值比较

Comparison of the predictive value of growth differentiation factor 15 and B-type natriuretic peptide for cardiovascular outcomes in patients with heart failure

目的 评估并比较生长分化因子15(GDF-15)和B型利钠肽(BNP)对心力衰竭(HF)患者随访1年发生不良心血管事件(MACE)的预测价值。方法 纵向队列研究。选取2017年1月至2019年12月在我院诊治的420例HF患者,入院时检测GDF-15和BNP,根据随访1年是否发生MACE事件(死亡、心力衰竭加重住院、新发急性冠脉综合征)分为MACE组(53例)和无MACE组(367例),比较两组的基线资料,Cox回归分析检验GDF-15、BNP与MACE的相关性,受试者工作特征(ROC)曲线比较GDF-15、BNP对MACE的预测价值,并比较不同GDF-15和BNP亚组患者的MACE发生风险。结果 420例患者中,女性199例(47.4%),年龄为(43.7±21.3)岁,左室射血分数(LVEF)为44.6%±5.3%。与无MACE组比较,MACE组的年龄、吸烟、心房颤动的比例更高,血肌酐、BNP和GDF-15水平更高,LVEF更低,β受体阻滞剂使用率也更低(均为P<0.05)。多因素Cox回归分析显示,GDF-15(HR=1.834,95%CI:1.107~2.538)和BNP(HR=1.637,95%CI:1.143~1.957)是预测MACE的因素。此外,年龄、缺血性HF、血肌酐和β受体阻滞剂也是MACE的相关因素(均为P<0.05)。ROC曲线结果显示,GDF-15和BNP预测MACE的曲线下面积分别为0.752和0.748。GDF-15预测HF患者发生MACE的预测价值不劣于BNP(P_(非劣性)=0.27)。结论 GDF-15对HF患者的MACE预测价值不劣于BNP。

Objective To evaluate and compare the predictive value of growth differentiation factor 15(GDF-15) and brain natriuretic peptide(BNP) in heart failure(HF) patients with adverse cardiovascular events(MACE) at 1-year follow-up.Methods This is a longitudinal cohort study.A total of 420 patients with HF who were diagnosed and treated in our hospital from January 2017 to December 2019 were selected.GDF-15 and BNP were tested on admission.According to the occurrence of MACE events(death,hospitalization for worsening heart failure,new occurrence of acute coronary syndrome),all were divided into MACE group(n=53) and non-MACE group(n=367).The baseline data of the two groups were compared,and the correlations between GDF-15,BNP and MACE were evaluated by Cox regression analysis.The predictive values of BNP and GDF-15 for MACE were evaluated by receiver operating characteristic(ROC) curve.Survival analysis and log-rank test compared the risk of MACE in patients with different GDF-15 and BNP subgroups.Results Among 420 patients,there were 199 females(47.4%),with an age of(43.7±21.3) years and an average left ventricular ejection fraction(LVEF) of 44.6%±5.3%.Compared with the non-MACE group,patients in the MACE group were older,had higher rates of smoking,atrial fibrillation,with higher serum creatinine,BNP,and GDF-15 levels,lower LVEF,and higher β-blocker usage(all P<0.05).Multivariate Cox regression analysis showed that GDF-15(HR=1.834,95%CI:1.107-2.538) and BNP(HR=1.637,95%CI:1.143-1.957) were the predictors of MACE.In addition,age,ischemic HF,serum creatinine,and β-blockers were also associated factors for MACE(all P<0.05).The ROC curve results showed that the areas under ROC curve of GDF-15 and BNP to predict MACE were 0.752 and 0.748,respectively.The predictive value of GDF-15 in predicting the occurrence of MACE was not inferior to BNP(P_(non-inferiority)=0.27).Conclusions The predictive value of GDF-15 for MACE in HF patients was not inferior to BNP.