血清生长分化因子-15水平对急性心肌梗死患者近期左室重构程度的预测价值

发布时间：2018-04-04 14:38

  本文选题：生长分化因子-15　切入点：左室重构指数　出处：《大连医科大学》2013年硕士论文

【摘要】：背景和目的：心力衰竭是多种心血管疾病的终末阶段，心室重构贯穿于心衰发生、发展的各个阶段。冠心病心肌缺血和（或）急性心肌梗死（Acute MyocardialInfarction,AMI）后，心室肌在缺血、缺氧等损伤性因素的持续作用下，心脏的大小、形态和功能逐渐发生改变，进一步发展为缺血性心肌病，是心力衰竭最常见的原因之一，严重威胁患者的生活质量及生命安全。因此，早期预测AMI患者的心室重构并终止或延缓其发生、发展具有非常重要的意义。有研究报道AMI发病早期N末端脑钠素原(N-terminal probrain natriuretic peptide，NT-proBNP)水平与晚期左室重构具有相关性，但其对左室重构的预测价值存在一定的局限性，因此寻找并发现更特异、更灵敏的生物标志物迫在眉睫。近年来多个多中心临床研究发现，生长分化因子-15(growth differentiation factor15，GDF-15)与心血管疾病相关，其作为心血管疾病的生物标记物具有重要的临床应用价值，其水平增高与急性冠状动脉综合征(acute coronary syndrome，ACS)的预后相关。在动物实验模型中，GDF-15在心衰的发生、发展过程中强烈表达，考虑其可能参与了心室重构的过程。临床研究报道，ST段抬高型心肌梗死患者发病24小时内血清GDF-15水平与1年后左室重构程度呈正相关，，但目前此类研究较少。本文旨在探讨AMI患者发病24小时内血清GDF-15水平与其近期左室重构程度的关系。 方法：从2012年6月～2012年12月就诊于大连医科大学附属第二医院心血管内科并明确诊断为急性心肌梗死的患者中选取59例，采集个人资料（包括年龄、性别、身高、体重、吸烟史、高血压病史、糖尿病病史等），测定血清GDF-15、NT-proBNP水平及其他相关实验室检查。所有患者于发病1周、1个月、3个月采用实时三维超声心动图（real-time three dimensional echocardiography，RT-3DE）测定左室重构相关指标，全容积法计算左室重构指数（left ventricular remodeling index，LVRI）。依据公式LVRI变化率=(LVRI1周或1月－LVRIX月)／LVRI1周或1月，计算患者发病1周~1个月、1周~3个月和1个月~3个月时的LVRI变化率。采用SPSS17.0软件进行数据的统计学处理，P＜0.05有统计学差异，P＜0.01有显著统计学差异。 结果： 1. AMI患者发病1周、1个月及3个月LVRI均有不同，发病1个月、3个月较1周时明显降低（1.30±0.17vs1.46±0.14，P0.01；1.15±0.20vs1.46±0.14，P0.01），3个月较1个月时明显降低（1.15±0.20vs1.30±0.17，P0.01）。 2.以1周~3个月的LVRI变化率中位数（20%）为标准，将所有患者分为轻度重构组（LVRI变化率20%）和重构重构组（LVRI变化率≥20%），重度重构组GDF-15、NT-ProBNP均明显高于轻度重构组（P0.05）。 3.相关性分析显示，GDF-15、NT-proBNP水平与LVRI变化率呈正相关（r=0.726，P=0.000；r=0.500，P=0.000)，且GDF-15与NT-proBNP呈正相关（r=0.544，P=0.000）；线性回归分析显示，GDF-15与LVRI变化率独立相关（P0.01），而NT-proBNP与LVRI变化率非独立相关（P0.05）。 4. ROC曲线分析比较GDF-15与NT-proBNP对急性心肌梗死患者3个月内左室重构程度的诊断效能，前者的灵敏度、特异度、Youden指数、曲线下面积均高于后者（AUC=0.817，P=0.000；AUC=0.680，P=0.017）。 结论： 1.AMI患者在发病3个月内发生了不同程度的左室重构。 2.高表达血清GDF-15水平是AMI患者近期发生左室重构的独立预测因子。 3.AMI患者血清GDF-15及NT-proBNP水平对左室重构程度均有一定的诊断价值，但前者诊断效能高于后者。
[Abstract]:Background and objective: heart failure is the end stage of many cardiovascular diseases, ventricular remodeling throughout all stages of development of heart failure, myocardial ischemia of coronary heart disease. And (or) acute myocardial infarction (Acute, MyocardialInfarction, AMI), ventricular myocytes during ischemia, hypoxia injury sustained effect factors, heart size, morphology and gradually change, further development of ischemic cardiomyopathy, is one of the most common causes of heart failure, a serious threat to the patient's quality of life and life safety. Therefore, the early prediction of ventricular remodeling in patients with AMI and terminate or delay the occurrence and development is very important. Studies have reported the incidence of early AMI N terminal brain natriuretic peptide the original (N-terminal probrain natriuretic peptide, NT-proBNP) is associated with late left ventricular remodeling, but the left ventricular remodeling of the predictive value of certain Bureau Limited, so look for and find more specific, more sensitive biomarkers imminent. In recent years, a multi center clinical study found that growth differentiation factor -15 (growth differentiation factor15, GDF-15) associated with cardiovascular disease, as a biomarker of cardiovascular disease has important clinical application value, the higher level and acute coronary artery syndrome (acute coronary, syndrome, ACS) prognosis. In animal models, GDF-15 in heart failure, strong expression in the development process, considering the involved in the process of ventricular remodeling. Clinical studies have reported that patients with ST segment elevation myocardial infarction within 24 hours of the serum GDF-15 level is associated with 1 years left ventricular remodeling after positively, but at present the research. This paper aims to explore the AMI patients within 24 hours of onset of serum GDF-15 levels and recent left ventricular remodeling. Relationship.
Methods: from June 2012 to December 2012 in the cardiovascular department of the Second Affiliated Hospital of Dalian Medical University and 59 cases were diagnosed as acute myocardial infarction patients were selected, the collection of personal data (including age, gender, height, weight, smoking history, history of hypertension, history of diabetes), serum GDF-15, NT-proBNP levels and other related laboratory tests. All patients in the incidence of 1 weeks, 1 months, 3 months using real-time three-dimensional echocardiography (real-time three dimensional echocardiography, RT-3DE) determination of left ventricular remodeling index, calculation of left ventricular remodeling index (left ventricular remodeling index volume, LVRI). According to the formula LVRI = change rate (LVRI1 weeks or January LVRIX / LVRI1 week or month) in January were calculated after 1 weeks ~1 months. The change of LVRI ~3 for 1 weeks and 1 months ~3 months. The rate of data mining system with SPSS17.0 software The P < 0.05 had statistical difference, and there were significant differences in P < 0.01.
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