生长分化因子15及其联合GRACE评分对非ST段抬高型急性冠脉综合征患者预后价值的研究

发布时间：2018-06-02 13:02

本文选题：GDF-15 + GRACE评分　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:研究人生长分化因子-15(Growth Differentiation Factor-15,GDF-15)及其联合全球急性冠状动脉事件注册(Global Registry of Acute Coronary Events,GRACE)风险评分对非ST段抬高型急性冠状动脉综合征(Non-ST elevated acute coronary syndrome,NSTE-ACS)患者的预后价值。方法:收集池州市人民医院2015年6月-2016年6月经冠状动脉造影证实是NSTE-ACS的住院患者73例作为实验组,同期经冠状动脉造影证实无冠脉病变的37例住院病人作为正常对照组,两组在性别、身高、年龄、体重等方面相匹配。运用酶联免疫吸附试验(Enzyme-Linked Immunosorbent Assay,ELISA)检测入院时的血清GDF-15水平,同时计算实验组的GRACE评分,比较实验组与对照组的血清GDF-15水平及GRACE评分大小。氨基末端脑钠素前体(N-terminal pro-brain natriuretic peptide,NTpro BNP)是离散型变量,对NTpro BNP取自然对数后符合正态分布,比较两组间NTpro BNP的自然对数值(In NTpro BNP)、左室射血分数(Left ventricular ejection fraction,LVEF)以及其他临床基础资料和血液生化资料的差异。运用Pearson相关性分析法分析血清GDF-15水平与NSTE-ACS患者GRACE评分、In NTpro BNP及LVEF等临床生化资料的相关性。对NSTE-ACS患者随访半年,记录半年内发生的主要不良心血管事件(Major adverse cardiovascular event,MACE)。结果:(1)NSTE-ACS患者组与对照组一般计量资料的比较:本研究共纳入110例住院患者,其中NSTE-ACS患者组(包括非ST抬高型心肌梗死患者及不稳定心绞痛患者)共73人,正常对照组37人。NSTE-ACS患者组与对照组在年龄、心率、收缩压(Systolic Blood Pressure,SBP)、总胆固醇(Total cholesterol,TC)、甘油三酯(Triglyceride,TG)、高密度脂蛋白(High density lipoprotein,HDL)、低密度脂蛋白(Low density lipoprotein,LDL)、尿酸、血红蛋白等一般计量资料差异无统计学意义(P0.05)。NSTE-ACS患者组LVEF明显低于患者组,NSTE-ACS患者组In NT-pro BNP、血清肌酐(Serum Creatinine,SCr)、血清GDF-15水平、明显高于对照组,差异有统计学意义(P0.01)。其中对NSTE-ACS组患者进行GRACE风险评分,结果为(100.720±23.790)分。(2)NSTE-ACS患者组与对照组一般计数资料比较:本研究中共有68例患者的心电图上存在ST段改变,其中NSTE-ACS患者组51例,对照组17例,NSTE-ACS患者组ST段改变患者、有吸烟史等人数比例较对照组明显升高,差异均有统计学意义(P0.05)。NSTE-ACS患者组中有饮酒史、糖尿病(diabetes mellitus,DM)史、有冠心病史人数比例、有心肌标志物升高患者比例以及男性患者比例较对照组差异无明显统计学意义(P0.05)。(3)NSTE-ACS患者组血清GDF-15水平与血液生化指标及临床基础资料相关性分析:Pearson相关性分析显示NSTE-ACS患者血清GDF-15水平与GRACE风险评分(r=0.576,P0.001)、In NTpro BNP(r=0.602,P0.001)、肌酐(r=0.286,P=0.003)均呈正相关。血清GDF-15水平与左室射血分数呈显著负相关(r=-0.608,P0.001)。血清GDF-15水平与NSTE-ACS患者TC、TG、HDL、LDL、血红蛋白无明显相关性(P0.05)。(4)血清GDF-15水平、GRACE评分及两者联合对NSTE-ACS患者预后的诊断价值评估:本研究对NSTE-ACS患者随访半年,记录其半年内发生的不良心血管事件数,共有73例NSTE-ACS患者完成了随访,共发生MACE事件26例,其中心源性死亡1例,再发心衰1例,再发心肌梗死1例,再发心绞痛23例,由受试者操作特征曲线(Receiver Operating Characteristic curve,ROC曲线)分析得出血清GDF-15水平预测NSTE-ACS患者MACE的曲线下面积0.862,(95%CI:0.773,0.951);敏感度84.60%,特异度85.10%。GRACE评分预测NSTE-ACS患者MACE的曲线下面积0.813,(95%CI:0.712,0.914);敏感度69.20%,特异度85.10%。血清GDF-15水平联合GRACE评分预测NSTE-ACS患者MACE的曲线下面积由血清GDF-15水平的0.862增加到0.873(95%CI:0.790,0.956),P0.05,差异有统计学意义。(5)单因素及多因素logistic回归分析:定义NSTE-ACS患者出现MACE为因变量,将可能影响NSTE-ACS患者预后的变量纳入单因素及多因素logistic回归分析,结果提示血清GDF-15水平、GRACE评分、In NT-pro BNP、LVEF、年龄、ST段改变为NSTE-ACS患者预后的危险因素(P0.05),其中血清GDF-15水平为校正其他危险因素后NSTE-ACS患者短期预后的独立危险因素(P0.05)。结论:1.NSTE-ACS患者血清GDF-15水平与GRACE评分呈正相关;2.血清GDF-15水平对NSTE-ACS患者预后有较高的诊断价值;3.联合血清GDF-15水平与GRACE评分可增加血清GDF-15水平或GRACE评分对NSTE-ACS患者预后的诊断价值;4.血清GDF-15水平是校正其他危险因素后NSTE-ACS患者预后的独立危险因素。
[Abstract]:Objective: To study the prognosis of human growth differentiation factor -15 (Growth Differentiation Factor-15, GDF-15) and the associated global acute coronary event registration (Global Registry of Acute Coronary Events, GRACE). Methods: a total of 73 hospitalized patients in Chizhou People's Hospital, which was confirmed by coronary angiography in 6 period of -2016 June 2015, were selected as the experimental group, and 37 hospitalized patients without coronary lesions confirmed by coronary angiography were used as the normal control group. The two groups matched the sex, body height, age, weight and so on. The use of enzyme linked immunosorbent assay was used in the two groups. The serum GDF-15 level was detected by Enzyme-Linked Immunosorbent Assay (ELISA), and the GRACE score of the experimental group was calculated. The serum GDF-15 level and the GRACE score were compared between the experimental group and the control group. The amino terminal brain natriuretic precursor (N-terminal pro-brain natriuretic peptide) was a discrete variable. NTpro BNP conforms to normal distribution after natural logarithm, and compares the difference between the natural pair value (In NTpro BNP), left ventricular ejection fraction (Left ventricular ejection fraction, LVEF) and other clinical basis data and blood biochemical data between the two groups of NTpro BNP. E score, the correlation of clinical biochemical data such as In NTpro BNP and LVEF. The major adverse cardiovascular events (Major adverse cardiovascular event, MACE) were recorded for half a year (Major adverse cardiovascular event, MACE) for six months of six months. Results: (1) a total of 110 cases of hospitalized patients were included in this study. ACS patients (including non ST elevation myocardial infarction and unstable angina pectoris) were 73, and 37 in normal control group and control group were in age, heart rate, systolic blood pressure (Systolic Blood Pressure, SBP), total cholesterol (Total cholesterol, TC), triglyceride (Triglyceride, TG), and high-density lipoprotein (HDL) Ein, HDL), low density lipoprotein (Low density lipoprotein, LDL), uric acid, hemoglobin and other general measurement data were not statistically significant (P0.05).NSTE-ACS patient group LVEF significantly lower than the patient group, NSTE-ACS patients group In NT-pro, serum creatinine, serum levels, significantly higher than the control group, the difference was statistically significant Meaning (P0.01). Among the patients in group NSTE-ACS, the GRACE risk score was scored (100.720 + 23.790). (2) a comparison of the general count data between the NSTE-ACS patients and the control group: there were 68 patients with ST segment changes in this study, of which 51 cases in NSTE-ACS patients, 17 in the control group, and in the ST segment of NSTE-ACS patients, with inhalation. The proportion of smoking history and other people was significantly higher than that of the control group. The difference was statistically significant (P0.05) in.NSTE-ACS patients, there were drinking history, diabetes (diabetes mellitus, DM) history, the proportion of people with coronary heart disease history, the proportion of patients with elevated myocardial markers and the proportion of male patients had no significant difference compared with those of the control group (P0.05). (3) NSTE-ACS The correlation analysis between serum GDF-15 level and blood biochemical index and clinical basic data in patients group: Pearson correlation analysis showed that serum GDF-15 level in NSTE-ACS patients was positively correlated with GRACE risk score (r=0.576, P0.001), In NTpro BNP (r=0.602, P0.001) and creatinine. Negative correlation (r=-0.608, P0.001). Serum GDF-15 level has no significant correlation with TC, TG, HDL, LDL, and hemoglobin in NSTE-ACS patients (P0.05). (4) serum GDF-15 level, GRACE score and the combination of the two for the prognosis of patients with NSTE-ACS: This study was followed up for half a year to record the number of adverse cardiovascular events occurring within half a year, A total of 73 patients with NSTE-ACS were followed up. There were 26 cases of MACE events, including 1 cases of cardiac death, 1 cases of recurrent heart failure, 1 cases of recurrent myocardial infarction and 23 cases of recurrent angina, and the curve of serum GDF-15 (Receiver Operating Characteristic curve, ROC curve) was divided into the curve of serum GDF-15 to predict the curve of MACE in NSTE-ACS patients. The lower area 0.862, (95%CI:0.773,0.951), sensitivity 84.60%, specificity 85.10%.GRACE score predicted the area under the curve of MACE in NSTE-ACS patients 0.813, (95%CI:0.712,0.914); sensitivity 69.20%, specific 85.10%. serum GDF-15 level combined with GRACE score predicted that the area under the curve of MACE in NSTE-ACS patients was increased from 0.862 to 0.873 of serum GDF-15. 95%CI:0.790,0.956), P0.05, the difference was statistically significant. (5) single factor and multiple factor Logistic regression analysis: the definition of NSTE-ACS patients with MACE as the dependent variable, the variables that may affect the prognosis of NSTE-ACS patients were included in the single factor and multiple factor Logistic regression analysis. The results showed serum GDF-15 level, GRACE score, In NT-pro BNP, age, The ST segment was a risk factor for the prognosis of NSTE-ACS patients (P0.05), and the serum GDF-15 level was an independent risk factor (P0.05) for the short-term prognosis of NSTE-ACS patients after correction of other risk factors. Conclusion: the serum GDF-15 level in 1.NSTE-ACS patients was positively correlated with the GRACE score, and the level of GDF-15 in 2. blood clearing GDF-15 had a higher diagnostic value for the prognosis of NSTE-ACS patients. 3. combined serum GDF-15 level and GRACE score can increase the diagnostic value of serum GDF-15 level or GRACE score for NSTE-ACS patients, and 4. serum GDF-15 level is an independent risk factor for the prognosis of NSTE-ACS patients after other risk factors.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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