GDF-15、HDL-C及cTnI检测联合CRUSADE评分在NSTE-ACS预后评估中的应用

目的探讨生长分化因子-15(GDF-15)、高密度脂蛋白胆固醇(HDL-C)及肌钙蛋白Ⅰ(cTnI)检测联合出血风险(CRUSADE)评分评估非ST段抬高的急性冠状动脉综合征(NSTE-ACS)预后的预测价值。方法选取2015年1月至2018年1月本院住院部治疗的102例NSTE-ACS患者设为观察组,根据CRUSADE评分分为低危组(n=34)、中危组(n=36)、高危组(n=32),选取同期110例体检的健康者为对照组。对比各组GDF-15、HDL-C及cTnI水平及不同预后的患者CRUSADE评分。随访3年,比较3组心肌缺血事件发生率、出血事件发生率及预后生存率,分析GDF-15、HDL-C及cTnI水平联合CRUSADE评分对NSTE-ACS患者预后死亡的预测价值。结果 GDF-15、cTnI水平:对照组<低危组<中危组<高危组,HDL-C水平:对照组>低危组>中危组>高危组,差异均有统计学意义(P<0.05)。高危组GDF-15及cTnI水平显著高于中危组及低危组,HDL-C水平明显低于中危组及低危组,差异有统计学意义(P<0.05),3组GDF-15、HDL-C及cTnI水平比较差异具有统计学意义(P<0.05)。高危组心肌缺血事件发生率、出血事件发生率均显著高于中危组及低危组,差异有统计学意义(P<0.05)。GDF-15及cTnI高表达、HDL-C低表达、CRUSADE评分≥41分的患者死亡率更高(P<0.05)。GDF-15、HDL-C、c TnI水平、CRUSADE评分及四者联合检测RCC曲线下面积分别为:0.839、0.803、0.876、0.938、0.978,各指标曲线下面积以联合检测最大。结论 NSTE-ACS患者GDF-15、HDL-C、cTnI水平呈异常表达状态,三者检测联合CRUSADE评分评估NSTE-ACS患者预后死亡的价值较高。

The application of GDF-15,HDL-C and cTnI detection combined with CRUSADE score in the prognosis assessment of NSTE-ACS

Objective To explore the value of growth differentiation factor-15(GDF-15),high density lipoprotein cholesterol(HDL-C)and troponin I(c Tn I)combined with crusade bleeding risk score(CRUSADE)in predicting the prognosis of non-ST-elevation acute coronary syndrome(ACS). Methods102 patients with non-ST-segment elevation ACS treated in this inpatient department from January 2015 to January 2018 were selected as the observation groupAccording to the CRUSADE score,they were divided into low-risk group(n=34),intermediate-risk group(n=36),and high-risk group(n=32)]. 110 healthy people who received physical examinations during the same period were selected as the control group. The levels of GDF-15,HDL-C and c Tn I in the three groups and the CRUSADE score of patients with different prognosis were compared. The patients were followed up for 3 years to compare the incidence of myocardial ischemia events,bleeding events and prognostic survival rates among the three groups. The predictive value of GDF-15,HDL-C and c Tn I levels combined with CRUSADE score for the prognostic death of patients with non-ST-segment elevation ACS was analyzed. Results The GDF-15 and c Tn I levels in the control group were significantly lower than those in the low-risk,intermediate,and high-risk groups,and the HDL-C level was significantly higher than that in the low-risk,intermediate,and high-risk groups(P<0.05). The levels of GDF-15 and c Tn I in the high-risk group were significantly higher than those in the intermediate-risk and low-risk groups,and the level of HDL-C was significantly lower than that in the medium-risk and low-risk groups. The differences in the levels of GDF-15,HDL-C and c Tn I among the three groups were statistically significant(P<0.05). The incidences of myocardial ischemia and bleeding events in the high-risk group were significantly higher than those in the intermediate-risk group and the low-risk group(P<0.05). The patients with high GDF-15 and c Tn I expression,low HDL-C expression,and CRUSADE score ≥ 41 had a higher mortality rate(P<0.05). The area under the RCC curve of GDF-15,HDL-C,c Tn I level,CRUSADE score and four combined detection were0.839,0.803,0.876,0.938,0.978,respectively. The area under the curve of combined detection was the largest. Conclusion The levels of GDF-15,HDL-C,and c Tn I in patients with non-ST-segment elevation ACS are abnormally expressed. The three tests combined with the CRUSADE score have a higher value in assessing the prognosis of death in NSTE-ACS patients.