生长分化因子15预测老年冠心病患者预后价值

Predicitve value of growth/differentiation factor-15 for elderly patients with coronary artery disease

目的观察生长分化因子15(GDF-15)在老年冠心病患者中的表达,分析其对冠状动脉风险预测能力。方法选择2010年10月~2014年9月解放军总医院第一医学中心的老年冠心病患者3120例,均行急诊或者择期冠状动脉造影检查,根据临床终点事件分为心血管事件组400例和无心血管事件组2720例。记录患者入院时基本临床信息、心电图采集等。全部患者随访,记录临床终点事件及发生时间。通过Cox回归分析观察GDF-15对心血管事件的预测能力。结果心血管事件组年龄、收缩压、高血压、糖尿病、脑卒中、心肌梗死、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、空腹血糖和GDF-15水平明显高于无心血管事件组,体质量指数、舒张压、吸烟、PCI/冠状动脉旁路移植术、LVEF、冠状动脉多支病变、他汀类药物和TG水平明显低于无心血管事件组(P<0.05,P<0.01)。所有患者中位随访2.9(1.2,4.8)年,共400例患者发生其中至少一项临床终点事件,包括心肌梗死、心血管死亡、脑卒中、心力衰竭、全因死亡。GDF-15与心力衰竭相关(HR=1.84,95%CI:1.72~2.00,P<0.01)。GDF-15对临床事件预测的截断值为3312 ng/L,GDF-15与再发临床缺血事件相关(P_(log rank)<0.01)。结论在老年冠心病人群中,GDF-15显著增加心血管事件风险预测能力,并提高对冠心病患者危险预测价值。

Objective To investigate the expression of GDF-15 in the olders with CAD,and evaluate its risk predication ability for CAD.Methods A total of 3120 elderly in-and out-patients in the department of cardiology of the Frist Medical Center of Chinese PLA General Hospital from October 2010 to September 2014 were enrolled in this study.All of them underwent elective or emergent coronary angiography.According to the occurrence of clinical endpoints,they were divided into cardiovascular event group(n=400)and non-cardiovascular event group(n=2720).The baseline clinical data and electrocardiograms were collected in all patients.Their clinical endpoints and onset time of the events were recorded during follow-up.Cox regression analysis was performed to analyze the predication ability of GDF-15 for cardiovascular events.Results The cardiovascular event group had older age,higher systolic blood pressure,larger ratios of hypertension,diabetes mellitus,stroke and myocardial infarction,usages of ACEI/ARB,and increased fasting blood glucose and GDF-15 than the non-cardiovascular event group(P<0.05,P<0.01).Lower BMI and diastolic blood pressure,ratio of smoking,history of PCI/CABG history,LVEF,proportion of multivessel disease,usage of statins and TG were observed in the cardiovascular event group than the non-cardiovascular events group(P<0.05,P<0.01).During a median follow-up of 2.9(1.2,4.8)years,400 patients experienced at least one of the clinical endpoints,in-cluding myocardial infarction,cardiovascular death,stroke,heart failure and all-cause death.Cox regression model showed that GDF-15 was related to heart failure(HR=1.84,95%CI:1.72-2.00,P<0.01),with a cutoff value of 3312 ng/L.That GDF-15 was associated with recurrent clinical ischemic events(P_(log rank)<0.01).Conclusion GDF-15 exibits risk prediction ability of car-diovascular events,and promotes risk predictive value in the elderly CAD patients.