生长分化因子—15与N末端—B型利钠肽原及超敏C反应蛋白在急性心力衰竭中的诊断价值

黄海燕 崔瑛 洪云玉

[摘要] 目的 探討血清生长分化因子-15（GDF-15）与N末端B型利钠肽原（NT-proBNP）及全血超敏C反应蛋白（hs-CRP）在不同严重程度急性心力衰竭（AHF）患者中的表达水平及诊断价值。 方法 选取吉林省延边第二人民医院急诊科于2014年4月～2016年4月收治的AHF患者77例（心衰组）及健康体检者60例（对照组）。采用ELISA法检测血清GDF-15、NT-proBNP，免疫层析法检测全血hs-CRP水平，常规做心电图和超声心动图检查左心室射血分数（LVEF）及胸部X线检查，分析GDF-15、NT-proBNP和hs-CRP的表达水平以及三者之间的相关性。 结果 与对照组比较，心衰组的GDF-15、NT-proBNP和hs-CRP的水平明显升高，左室射血分数（LVEF）明显降低，差异有统计学意义（P < 0.05）;临床程度Ⅰ～Ⅳ级患者NT-proBNP、hs-CRP水平有升高趋势，差异无统计学意义（P > 0.05）;GDF-15、hs-CRP与NT-proBNP水平呈正相关，hs-CRP与NT-proBNP呈正相关，LVEF、GDF-15与NT-proBNP呈负相关（P < 0.01）;ROC曲线分析显示NT-proBNP、GDF-15、hs-CRP的曲线下面积对AHF的诊断比较，差异有统计学意义（P < 0.05），诊断能力NT-proBNP>GDF-15>hs-CRP。 结论 血清GDF-15、NT-proBNP、全血hs-CRP水平在AHF中明显升高，且随着临床严重程度增加而升高。血清GDF-15可以作为AHF患者诊断、治疗、判断预后的又一新指标，其联合NT-proBNP和hs-CRP检测对AHF的诊治、危险分层、预后判断意义更大。

[关键词] 急性心力衰竭;左室射血分数;生长分化因子-15;N末端-B型利钠肽原;超敏C反应蛋白

[中图分类号] R541.6 [文献标识码] A [文章编号] 1673-7210（2018）04（b）-0054-05

[Abstract] Objective To explore the expression level and diagnostic value of serum growth differentiation factor-15 （GDF-15）， N-terminal B-type natriuretic peptide prosoma （NT-proBNP） and high-sensitivity C-reactive protein （CRP） in patients with acute heart failure （AHF） and patients with different severity of AHF. Methods A total of 77 patients with AHF （AHF group） and 60 cases of healthy examined people （control group） from April 2014 to April 2016 in the Second Hospital of Yanbian were selected. The expression level of serum GDF-15 and NT-proBNP were detected by ELISA， the expression of hs-CRP was detected by immunochromatography， routine electrocardiogram and echocardiography were performed to examine the left ventricular ejection fraction （LVEF） and chest X-ray examination. The correlation between GDF-15， NT-proBNP， hs-CRP expression level and the three factors were analyzed. Results Compared with the control group， the expression of GDF-15， NT-proBNP and hs-CRP were significantly increased and the left ventricular ejection fraction （LVEF） was significantly reduced in AHF group， the difference was statistically significant （P < 0.05）. The levels of NT-proBNP， hs-CRP among clinical grades Ⅰto Ⅳ had increased trend， the difference was not statistically significant （P > 0.05）. GDF-15 and hs-CRP were positively correlated to NT-proBNP， hs-CRP was positivly correlated to NT-proBNP， LVEF and GDF-15 were negatively correlated to NT-proBNP （P < 0.01）. The ROC curve analysis showed that the areas under the curve of NT-proBNP， GDF-15 and hs-CRP had statistical significance in diagnosing AHF （P < 0.05）， the diagnostic ability was NT-proBNP > GDF-15 > hs-CRP. Conclusion The serum levels of GDF-15， NT-proBNP and hs-CRP are significantly elevated in patients with AHF， and increasd as the clinical severity. The serum GDF-15 can be used as a new index for diagnosis， treatment and estimating prognosis of patients with AHF. GDF-15 combined with the detection of NT-proBNP and hs-CRP has great significance in diagnosing and treating， distinguishing risk stratification and judging prognosis AHF.

[Key words] Acute heart failure; Left ventricular ejection fraction; Growth differentiation factor-15; N-terminal B-type natriuretic peptide prosoma; High-sensitivity-C-reactive protein

急性心力衰竭是临床常见的急危重症之一，常常危及生命;急性心力衰竭早发现、早诊断对患者的治疗效果与预后意义重大。近年来研究认为B型利钠肽（BNP）/N末端B型利钠肽原（NT-proBNP）可提供心衰患者心脏结构和功能发生异常的客观佐证;因此常用其动态变化来指导心力衰竭的诊断治疗。研究还发现生长分化因子-15（GDF-15）和超敏C反应蛋白（hs-CRP）在心血管疾病进展过程中也发挥了相应的作用;在慢性心力衰竭患者外周血中表达较为明显[1]。G……