血清生长分化因子-15与先天性心脏病患儿心功能的关系及其对心力衰竭的诊断价值

Plasma concentration of growth-differentiation factor-15 in children with congenital heart disease: relation ship to heart function and diagnostic value in heart failure

摘要:

目的：探讨生长分化因子-15（GDF-15）与先天性心脏病患儿心功能的关系及其对心力衰竭的诊断价值。方法：2011年3月至2012年5月成都市妇女儿童中心医院就诊的先天性心脏病患儿97例，依据改良Ross评分法分为心力衰竭组（71例）和无心力衰竭组（26例）。ELISA法检测两组血清GDF-15和B型脑钠肽前体(NT-proBNP)水平，超声心动图检测左室射血分数(LVEF)。采用Spearman相关分析对GDF-15与改良Ross评分、LVEF及NT-proBNP的相关关系进行分析。绘制ROC曲线并计算GDF-15曲线下面积及诊断心力衰竭的截断值。结果：心力衰竭组患儿血清GDF-15和NT-proBNP水平较无心力衰竭组显著增高，LVEF明显降低，差异有统计学意义(P<0.01)。血清GDF-15水平与改良Ross评分及血清NT-proBNP水平呈正相关（分别r=0.705和0.810，P<0.01），与LVEF呈负相关（r=－0.421，P<0.01）。GDF-15诊断心力衰竭的ROC 曲线下面积为0.757，当GDF-15的诊断界值为1306 ng/L，敏感性和特异性分别为68.8%和71.2%。结论：先天性心脏病合并心力衰竭患儿血清GDF-15明显升高，血清GDF-15水平与先天性心脏病患儿心功能、LVEF及NT-proBNP水平均有不同程度的相关关系；GDF-15可能成为诊断小儿先天性心脏病合并心力衰竭的一项检测指标。

Abstract:

OBJECTIVE: To study the correlation between growth differentiation factor-15(GDF-15) and cardiac function in pediatric patients with congenital heart disease, and the diagnositic value of GDF-15 in heart failure(HF). METHODS: From March 2011 to May 2012, 97 pediatric patients with congenital heart disease(CHD) who consecutively attended Chengdu Women′s & Children′s Central Hospital were enrolled in the study and assigned to HF (patients with heart failure, n=71) and Non-HF(patients without heart failure, n=26) groups. HF was defined as patients presenting with modified Ross score≥3. Plasma concentrations of GDF-15 and NT-proBNP were determined using ELISA. Left ventricular ejection fraction(LVEF) was tested by echocardiography. The correlation between GDF-15 and modified Ross score, LVEF and NT-proBNP was evaluated with Spearman′s analysis. The area under the receiver-operating characteristic(ROC) curve for GDF-15 was examined, and the cut-off concentration of GDF-15 for diagnosing HF was detected. RESULTS: The HF group demonstrated higher levels of GDF-15 and NT-proBNP, and a lower LVEF level (P<0.01) than the Non-HF group. Plasma GDF-15 level was positively correlated with modified Ross score and plasma NT-proBNP comcentration (r=0.705, r=0.810 respectively; P<0.01), and negatively correlated with LVEF(r=-0.391, P<0.01). According to ROC analysis, the AUC of GDF-15 for detection of HF was 0.757. Sensitivity and specificity was 68.8% and 71.2% respectively for the cut-off value of 1306 ng/mL. CONCLUSIONS: Plasma GDF-15 levels are significantly elevated in children with HF induced by CHD. Plasma GDF-15 levels are related to cardiac function, LVEF and plasma concentration of NT-proBNP. GDF-15 may potentially indicate HF in pediatric patients with CHD.