血清NT-proBNP、GDF-15、PICP和PIIICP对心绞痛并发急性左心衰竭的预测价值

Predictive value of serum NT-proBNP,GDF-15,PICP and PIIICP for acute left ventricular failure in patients with angina pectoris

目的:探讨血清N末端脑钠肽前体(NT-proBNP)、生长分化因子-15(GDF-15)、Ⅰ型前胶原羧基端肽(PⅠCP)、Ⅲ型前胶原羧基端肽(PⅢCP)水平对心绞痛并发急性左心衰竭(ALVF)的预测价值。方法:选择2019年7月至2021年10月中国地质大学(武汉)医院收治的316例心绞痛患者作为研究组,另同期招募在医院行健康体检的200例健康受试者作为对照组,比较两组血清NT-proBNP、GDF-15、PⅠCP、PⅢCP水平。观察住院期间研究组患者ALVF发生情况,采用多因素Logistic回归分析心绞痛患者并发ALVF的影响因素,ROC曲线分析上述血清指标对心绞痛患者并发ALVF的预测价值。结果:与对照组比较,研究组血清NT-proBNP、GDF-15、PⅠCP、PⅢCP水平均显著升高(P均<0.001);与稳定型心绞痛患者比较,不稳定型心绞痛患者上述血清指标水平均显著升高(P均<0.001)。多因素Logistic回归分析显示,年龄≥65岁、不稳定型心绞痛、心绞痛Ⅲ级及血清NT-proBNP、GDF-15、PⅠCP、PⅢCP水平均是心绞痛患者并发ALVF的独立危险因素(OR=1.885~3.428,P<0.05或<0.01);ROC分析显示,血清NT-proBNP、GDF-15、PⅠCP、PⅢCP联合检测预测心绞痛并发ALVF的曲线下面积为0.947,显著高于各指标单独检测(AUC=0.826、0.727、0.759、0.733,P<0.05或<0.01)。结论:血清NT-proBNP、GDF-15、PⅠCP、PⅢCP水平在心绞痛患者中显著升高,均是心绞痛并发ALVF的独立危险因素,四项联合检测对此类患者并发ALVF具有较高的预测价值。

Objective:To explore the predictive value of serum levels of N-terminal pro brain natriuretic peptide(NT-proBNP),growth differentiation factor-15(GDF-15),type I procollagen C-terminal propeptide(PICP)and typeⅢprocollagen C-terminal propeptide(PIIICP)for acute left ventricular failure(ALVF)in patients with angina pectoris.Methods:A total of 316 patients with angina pectoris who were treated in Hospital of China University of Geosciences(Wuhan)between July 2019 and October 2021 were selected as study group,another 200 healthy subjects undergoing physical examination in our hospital simultaneously were enrolled as control group,then serum levels of NT-proBNP,GDF-15,PICP and PIIICP were compared between two groups.Incidence of ALVF in study group during hospitalization was observed.Multivariate Logistic regression was used to analyze influencing factors of ALVF in patients with angina pectoris,and ROC curve was used to analyze predictive value of above serum indexes for ALVF in patients with angina pectoris.Results:Serum levels of NT-proBNP,GDF-15,PⅠCP and PⅢCP in the study group were significantly higher than those in the control group(P<0.001 all).Serum levels of above indexes in patients with unstable angina pectoris were significantly higher than those of patients with stable angina pectoris(P<0.001 all).Multivariate Logistic regression analysis indicated that age≥65 years,unstable angina pectoris,angina grade III and serum levels of NT-proBNP,GDF-15,PⅠCP and PⅢCP were independent risk factors of ALVF in angina patients(OR=1.885~3.428,P<0.05 or<0.01);ROC analysis indicated that area under the curve of combined detection of serum NT-proBNP,GDF-15,PⅠCP and PⅢCP predicting ALVF in angina patients was 0.947,which was significantly higher than single detection of above indexes(AUC=0.826,0.727,0.759,0.733,P<0.05 or<0.01).Conclusion:Serum levels of NT-proBNP,GDF-15,PⅠCP and PⅢCP significantly increase in angina patients,and they are all independent risk factors of ALVF in angina pectoris,and the combination of the four indexes has high predictive value for ALVF in these patients.