血清GDF11、Copeptin水平对充血性心力衰竭病人新活素治疗疗效及死亡风险的预测作用

Predictive effects of serum levels of GDF11 and Copeptin in the therapeutic effects and death risk of congestive heart failure patients treatment with Nesiritide

目的:探讨血清生长分化因子11(growth differentiation factor 11,GDF11)、羧基端糖基化肽(Copeptin)水平对充血性心力衰竭(CHF)病人新活素治疗疗效及死亡风险的预测作用。方法:选取156例CHF病人,均给予新活素治疗,比较受试者治疗前后NYHA心功能分级、心电图QRS宽度、左心室舒张末期内径(LVEDD)、左室射血分数(LVEF)、血清GDF11和Copeptin的水平。随访至2021年10月,根据病人预后情况,对2组病人基线资料采用单因素和多因素logistic回归分析,并应用受试者工作特征曲线(ROC)分析血清GDF11、Copeptin预测死亡风险的价值。结果:治疗前NYHA心功能分级中,Ⅱ级为48例,Ⅲ级为36例,Ⅳ级为72例,治疗后NYHA心功能分级Ⅰ级为29例,Ⅱ级为67例,Ⅲ级为43例,Ⅳ级为17例,心功能明显改善(P<0.01);治疗后QRS宽度和LVEDD数值明显低于治疗前(P<0.01),LVEF数值明显高于治疗前(P<0.01),GDF11和Copeptin数值明显低于治疗前(P<0.01);Pearson相关分析显示,血清GDF11和Copeptin均与LVEDD(r=0.291和0.268)和QRS宽度(r=0.247和0.222)成正相关关系(P<0.01),而与LVEF(r=-0.310和-0.261)成负相关关系(P<0.01);随访至2021年10月,失访5例,中位随访时间为(29.23±3.00)个月。死亡组病人的hs-CRP、TNF-α、GDF11和Copeptin指标均高于生存组(P<0.01)。logistic回归分析结果表明血清GDF11(OR=1.702,95%CI:1.348~2.150)和血清Copeptin(OR=2.166,95%CI:1.458~3.219)是CHF病人死亡的影响因素(P<0.01)。根据ROC曲线可得,血清GDF11诊断的临界值为765.44 ng/mL,其对应的敏感度为70.37%,特异性为70.16%,AUC为0.785(95%CI:0.730~0.839);血清Copeptin诊断的临界值为26.29 pmol/L,其对应的敏感度为59.26%,特异性为59.68%,AUC为0.635(95%CI:0.571~0.700)。两者联合诊断的敏感度为88.89%,特异性为78.23%,AUC为0.878(95%CI:0.831~0.908),敏感度和AUC明显高于GDF11和Copeptin单独预测(P<0.05)。结论:应用新活素治疗CHF效果确切,可有效改善心功能,且降低血清GDF11和Copeptin。血清GDF11和Copeptin是CHF死亡的独立影响因素,且可通过联合诊断提高预测CHF病人死亡的诊断效能。

Objective:To investigaste the predictive effects of serum levels of growth differentiation factor 11(GDF11)and Copeptin in the therapeutic effects and death risk of congestive heart failure(CHF)patients treated with Nesiritide.Methods:A total of 156 CHF patients were selected,and treated with Nesiritide.The NYHA cardiac function grade,ECG QRS width,left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF)and serum levels of GDF11 and Copeptin were compared before and after treatment.The patients were followed up to October 2021,and divided into the survival group and death group according to their prognosis.The univariate and multivariate logistic regression analysis were used to analyze the baseline data of two groups,and the receiver operating characteristic curve(ROC)was used to analyze the value of serum GDF11 and Copeptin in predicting the risk of death.Results:In NYHA cardiac function classification before treatment,48 cases were gradeⅡ,36 cases were gradeⅢand 72 cases were gradeⅣ.In NYHA cardiac function grading after treatment,29 cases were gradeⅠ,67 cases were gradeⅡ,43 cases were gradeⅢand 17 cases were gradeⅣ,the cardiac function were significantly improved(P<0.01).After treatment,the QRS width and LVEDD values were significantly lower than those before treatment(P<0.01),the LVEF values were significantly higher than those before treatment(P<0.01),and the GDF11 and Copeptin values were significantly lower than those before treatment(P<0.01).The results of Pearson correlation analysis showed that the serum levels of GDF11 and Copeptin were positively correlated with LVEDD(r=0.291 and 0.268)and QRS width(r=0.247 and 0.222)(P<0.01),and negative correlation with LVEF(r=-0.310 and-0.261)(P<0.01).The patients were followed up to October 2021,and the median follow-up time was(29.23±3.00)months.The indexes of hs-CRP,TNF-α,GDF11 and Copeptin in the death group were higher than those in survival group(P<0.01).The results of logistic regression analysis showed that the serum levels of GDF11(OR=1.702,95%CI:1.348-2.150)and serum Copeptin(OR=2.166,95%CI:1.458-3.219)were the influencing factors of the death of CHF patients(P<0.01).According to the ROC curve,the critical value of serum GDF11 diagnosis was 765.44 ng/mL,the corresponding sensitivity,specificity and AUC were 70.37%,70.16%,and 0.785(95%CI:0.730-0.839),respectively.The critical value of serum Copeptin diagnosis was 26.29 pmol/L,the corresponding sensitivity,specificity and AUC were 59.26%,59.68%and 0.635(95%CI:0.571-0.700),respectively.The sensitivity,specificity and AUC of the combined diagnosis were 88.89%,78.23%and 0.878(95%CI:0.831-0.908),resdpectively,which were significantly higher than those of GDF11 and Copeptin alone(P<0.05).Conclusions:The treatment of CHF with Nesiritide is effective,which can effectively improve the cardiac function,and reduce the serum levels of GDF11 and Copeptin.The serum GDF11 and Copeptin are the independent influencing factors of CHF death,and which can improve the diagnostic efficiency of predicting death in CHF patients through combined diagnosis.