eGFR及GDF-15对冠心病人群心血管事件预警作用的临床研究

发布时间：2018-10-15 13:48

【摘要】：目的:1.分析eGFR、GDF-15对冠心病人群心血管事件风险的预测和评估作用;2.将传统和新型生物标记物结合,为急性心血管事件提供试验和临床依据;方法:1.病人来源:本实验随机连续选取2012年1月至2015年12月期间,在解放军总医院住院处确诊为冠状动脉粥样硬化性心脏病(通过造影或者冠脉CTA确诊冠心病,包括稳定型心绞痛、不稳定型心绞痛、心肌梗死、PTCA/PCI术后、CABG术后)的住院病人3700例,随访时间为1-3.5年;2.建立标本库:统计研究对象的基本资料(包括年龄、入院日期、性别、联系方式等),收集血、尿标本,完成基线资料的采集(病史、体格检查、心电图、超声心动图、颈动脉超声、用药情况等);3.常规、生化指标及新型血浆标记物检测:常规、生化指标的检测包括血常规、空腹血糖、肌酐、CK-MB、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、lp (a)、胱抑素C、糖化血红蛋白、凝血常规、尿酸等,新型风险标记物GDF-15的检测用ELISA法完成;4.数据管理及统计分析:所有实验数据用Excel表格记录,应用SPSS统计软件处理数据(包括cox回归、ROC Analysis、C-statistic等)。结果:1.随访期间,450名实验对象发生心血管事件(包括心血管死亡、全因死亡、心肌梗死、脑卒中、心衰再住院);2.在随访期间发生心血管事件的冠心病患者相较之未发生心血管事件的冠心病患者,eGFR水平较低。Cox回归及logistic回归结果显示只有eGFR水平(P0.05)和年龄(P0.01)对于心血管事件具有独立预测作用。ROC曲线结果显示,eGFR水平与心血管事件的发生相关(曲线下面积为0.71,95%CI 区间为 0.68-0.74);3.在随访期间发生心血管事件的冠心病患者较之未发生心血管事件的冠心病患者,ROC曲线结果显示,GDF-15与心血管事件的发生相关(曲线下面积为0.71,95%CI区间为0.69-0.74)。联合别的相关因素如年龄、性别、吸烟等之后,GDF-15与心血管事件发生的相关性更大(曲线下面积为0.80)。Cox回归结果显示GDF-15水平与冠心病人群心血管事件发生相关(P0.05)。将GDF-15的水平做四分位后发现,GDF-15浓度越高,相关性越强。结论:1.在3.5年的随访中,eGFR及GDF-15水平与冠心病人群中心血管事件发生密切相关,eGFR及GDF-15水平可作为心血管事件发生的独立危险因素。2.较传统危险因素,eGFR和GDF-15水平显著增加了心血管事件风险预测能力。3. eGFR和GDF-15具有负相关性。
[Abstract]:Objective: 1. To analyze the role of eGFR,GDF-15 in predicting and evaluating cardiovascular events in patients with coronary heart disease. 2. Combination of traditional and new biomarkers to provide experimental and clinical evidence for acute cardiovascular events. Methods: 1. Patient sources: the patients were randomly selected from January 2012 to December 2015 to be diagnosed as coronary atherosclerotic heart disease (coronary artery disease, including stable angina pectoris, including stable angina pectoris) in the hospital of PLA General Hospital (coronary arteriography or coronary CTA, including stable angina pectoris). 3700 patients with unstable angina pectoris, myocardial infarction, postoperative PTCA/PCI, CABG operation were followed up for 1 to 3.5 years. Establishment of specimen bank: basic data (including age, date of admission, sex, contact method, etc.), blood and urine samples collected, baseline data collected (history, physical examination, electrocardiogram, echocardiography, etc.) Carotid ultrasound, medication, etc. Routine, biochemical and new plasma markers: routine, biochemical tests include blood routine, fasting blood glucose, creatinine, CK-MB, total cholesterol, triglyceride, high density lipoprotein, Low density lipoprotein (LDL), lp (a), cystatin C, glycosylated hemoglobin, coagulation routine, uric acid, GDF-15, a new risk marker, were detected by ELISA method. Data management and statistical analysis: all experimental data are recorded in Excel tables and processed by SPSS statistical software (including cox regression, ROC Analysis,C-statistic, etc.). The result is 1: 1. During the follow-up period, 450 subjects experienced cardiovascular events (including cardiovascular deaths, all-cause deaths, myocardial infarction, stroke, and rehospitalization of heart failure); 2. The level of eGFR in CHD patients with cardiovascular events during follow-up was lower than that in patients without cardiovascular events. Cox regression and logistic regression showed that only eGFR levels (P0.05) and age (P0.01) were associated with cardiovascular events. The ROC curve showed that the eGFR level was correlated with the occurrence of cardiovascular events (the area under the curve was 0.71-0.74 CI = 0.68-0.74). The results of ROC curve showed that there was a correlation between GDF-15 and cardiovascular events in the patients with coronary heart disease who had cardiovascular events during the follow-up period (the area under the curve was 0.7195 CI = 0.69-0.74). Combined with other related factors such as age, sex, smoking and so on, the correlation between GDF-15 and cardiovascular events was more significant (the area under the curve was 0.80). Cox regression results showed that the level of GDF-15 was associated with cardiovascular events in coronary heart disease population (P0.05). Four quartiles of GDF-15 level showed that the higher the concentration of GDF-15, the stronger the correlation. Conclusion: 1. During 3. 5 years follow-up, the levels of eGFR and GDF-15 were closely related to the occurrence of cardiovascular events in patients with coronary heart disease. The levels of eGFR and GDF-15 could be regarded as independent risk factors of cardiovascular events. 2. Compared with the traditional risk factors, the levels of eGFR and GDF-15 significantly increased the ability of predicting cardiovascular event risk. 3. EGFR and GDF-15 were negatively correlated.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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