充血性心力衰竭患者血浆生长分化因子-15 水平变化及临床意义

摘要： 目的 观察充血性心力衰竭（CHF）患者血浆生长分化因子（GDF） -15 水平的变化， 并探讨其临床意义。方法 选取 CHF 患者 100 例 （心衰组） 和健康体检者 30 例 （对照组）； 心衰组按美国纽约心脏病协会 （NYHA） 心脏功能分级分为 NYHAⅡ级组 35 例、 Ⅲ级组 32 例、 Ⅳ级组 33 例， 按左室射血分数（LVEF）水平分为 LVEF<0.4 组 52 例和 LVEF≥0.4 组 48 例。采用 ELISA 法检测血浆 GDF-15、 B 型利钠肽 （BNP） 水平， 常规超声心动图测定 LVEF、 左室舒张末期内径（LVDd）、 收缩末期内径（LVDs）及左室短轴缩短率（LVFS）， 分析 GDF-15 与 NYHA 分级、 BNP 及超声心动图各指标的相关性。结果 与对照组相比， NYHAⅡ~Ⅳ级组 BNP、 GDF-15、 LVDd、 LVDs 基本呈升高趋势， LVEF、 LVFS 基本呈下降趋势（P＜0.05）。对照组、 LVEF≥0.4 组和 LVEF<0.4 组 BNP、 GDF-15、 LVDd、 LVDs 依次升高， LVFS 依次降低， 组间多重比较差异均有统计学意义（均 P＜0.05）。血浆 GDF-15 水平与 BNP、 NYHA 分级、 LVDd、 LVDs 呈正相关 （r=0.524、 0.286、 0.453、 0.531， 均 P < 0.05）， 与 LVEF、 LVFS 呈负相关 （r= -0.592、 -0.587， 均 P < 0.05）。结论 血浆 GDF-15 可作为 CHF 诊断、 治疗、 判断预后的又一新指标。

Changes and its clinical significance of the plasma growth differentiation factor-15 in patients with chronic congestive heart failure

Abstract: Objective To investigate the changes and clinical significance of the plasma growth differentiation factor- 15 (GDF-15) in patients with chronic congestive heart failure (CHF). Methods A total of 100 patients with CHF were in? cluded in this study (CHF group), and 30 healthy persons were used as control group. CHF group was divided into heart func?tionⅡgrade (n=35)， Ⅲ grade (n=32)， Ⅳ grade (n=33) groups in accordance with New York Heart Association (NYHA). And CHF group was also divided into left ventricular ejection fraction (LVEF) <0.4 grade (n=52) and LVEF≥0.4 grade (n=48) groups in accordance with LVEF of patients. The plasma GDF-15 and brain natriuretic peptide (BNP) levels were detected by ELISA. The values of LVEF, left ventricular end-diastolic diameter (LVDd), left ventricular systolic diameter (LVDs) and left ventricular fractional shortening (LVFS) were detected by echocardiography. The correlation of GDF-15, NYHA classifi? cation, BNP and index of echocardiography was analyzed between groups. Results Compared with control group, the levels of BNP, GDF-15, LVDd and LVDs were significantly higher in heart failure group, and values of LVEF and LVFS were sig? nificantly lower (P < 0.05). The plasma levels of BNP, GDF-15, LVDd and LVDs were in turn increased in control group, LVEF≥0.4 grade group and LVEF<0.4 grade group. The plasma levels of LVFS were in turn decreased, in control group, LVEF≥0.4 grade group and LVEF<0.4 grade group (P＜0.05). There were positive correlations between the plasma levels of GDF-15 and BNP, NYHA, LVDd and LVDs (r=0.524, 0.286, 0.453 and 0.531, P < 0.05). The plasma level of GDF-15 was negatively correlated with LVEF and LVFS (r= -0.592, -0.587， P < 0.05). Conclusion The plasma level of GDF-15 can be used as a new marker for diagnosis, treatment and prognosis in patients with chronic congestive heart failure.