老年维持性血液透析患者血清GDF11和Cdc42变化与心血管事件的相关性研究

Correlation between changes in serum levels of GDF11 and Cdc42 and major adverse cardiovascular events in maintenance hemodialysis elders

目的探究老年维持性血液透析患者血清生长分化因子11(growth differentiation factor 11,GDF11)、细胞分裂周期蛋白42(cell division cycle 42,Cdc42)水平变化与患者发生主要不良心血管事件(major adverse cardiac events,MACE)的相关性。方法选择四川省南充市中心医院2019年6月至2021年6月收治的164例老年维持性血液透析患者作为观察对象(血液透析组),同时选取同时期未进行血液透析的老年终末期肾病患者150例作为未血液透析组,在本院体检的健康老年人员148名作为对照组,根据2年内是否发生MACE,将患者分为非MACE组92例和MACE组72例,采用酶联免疫吸附法测定血清GDF11、Cdc42水平,多因素Logistic回归分析影响老年维持性血液透析患者2年发生MACE的影响因素,受试者工作特征曲线分析GDF11、Cdc42水平对老年维持性血液透析患者发生MACE的预测价值。结果对照组、未血液透析组及血液透析组之间比较,血液透析组患者血清中GDF11水平[(640.38±137.55)μg/L比(851.56±215.61)μg/L,(785.27±174.62)μg/L]显著降低(t=10.414,P<0.001),Cdc42水平[(57.22±11.34)μg/L比(35.61±10.25)μg/L,(43.58±10.72)μg/L]显著升高(t=17.589,P<0.001);MACE组Cdc42水平显著高于非MACE组[(65.31±21.22)μg/L比(50.89±15.56)μg/L],GDF11水平显著低于非MACE组[(576.56±125.71)μg/L比(690.33±159.84)μg/L],差异具有统计学意义(均P<0.05)。GDF11、Cdc42水平和二者联合预测发生MACE的曲线下面积分别为0.762、0.794、0.868,二者联合预测的价值优于单独预测(Z=3.183、3.047;P=0.002、0.002)。结论老年维持性血液透析患者血清中GDF11水平降低,Cdc42水平升高,二者均与患者MACE发生密切相关,可能作为老年终末期肾病血液透析患者病情诊断、治疗和预后评估的标志物。

Objective To explore the changes in serum levels of growth differentiation factor 11(GDF11)and cell division cycle 42(Cdc42)in maintenance hemodialysis(MHD)elders and examine their correlations with events and occurrence of major adverse cardiovascular events(MACE).Methods From June 2019 to June 2021,164 MHD elders were selected as observation subjects(hemodialysis group)while 150 ESRD elders undergoing no hemodialysis during the same period as nonhemodialysis group.And 148 healthy elders receiving physical examinations were designated as control group.According to whether or not MACE occurred within 2 years,they were assigned into two groups of non-MACE(n=92)and MACE(n=72).Enzyme-linked immunosorbent assay(ELISA)was utilized for determining serum levels of GDF11 and Cdc42. Multivariate Logistic regression was applied for examiningthe influencing factors of 2-year MACE and receiver operating characteristic (ROC) curve for determiningthe predictive value of GDF11 and Cdc42 levels for MACE. Results As compared with control,non-hemodialysis and hemodialysis groups, serum level of GDF11 [(640.38 ± 137.55)vs(851.56 ±215.61),(785.27 ± 174.62)μg/L]declined obviously in hemodialysis group (t = 10.414, P<0.001) whileCdc42 level rose sharply [(57.22 ± 11.34) vs (35.61 ± 10.25), (43.58 ± 10.72) μg/L] (t = 17.589,P< 0.001). Cdc42 levels [(65.31 ± 21.22) vs (50.89 ± 15.56) μg/L] were obviously higher in MACEgroup than those in non-MACE group. GDF11 level [(576.56 ± 125.71) vs (690.33 ± 159.84) μg/L] wasobviously lower than that in non-MACE group and the differences were statistically significant (P<0.05).AUC of GDF11/Cdc42 level and their combined prediction for MACE was 0.762, 0.794 and 0.868 respectively.The value of combined prediction was better than that of individual prediction (Z = 3.183, 3.047;P = 0.002, 0.002). Conclusion In MHD elders, lower serum level of GDF11 and higher level of Cdc42are correlated closely with the occurrence of MACE. GDF11 and Cdc42 may be used as markers for managingand assessing ESRD MHD elders.