血清GDF-11及TSG-6水平与扩张型心肌病患者心力衰竭风险的相关性

doi:10.3760/cma.j.issn.1007-1245.2024.08.003

摘要/Abstract

摘要：

目的　探究血清生长分化因子11（GDF-11）、肿瘤坏死因子α刺激基因-6（TSG-6）水平与扩张型心肌病（DCM）患者心力衰竭风险的相关性。方法　回顾性选取深圳市龙华区人民医院2019年8月至2022年5月期间收治的174例DCM患者，其中男性患者87例，女性患者87例，年龄50～82岁。根据患者1年内是否并发心力衰竭将其分为心力衰竭组（84例）和无心力衰竭组（90例）。患者均进行血清GDF-11、TSG-6水平测定，收集两组患者临床资料并进行比较，多因素logistic回归分析法分析DCM患者发生心力衰竭的影响因素，用受试者操作特征曲线（ROC）分析血清GDF-11、TSG-6水平对DCM患者发生心力衰竭的预测价值，用Kaplan-Meier（KM）曲线分析GDF-11、TSG-6水平与患者发生心力衰竭的关系。行χ²检验、独立样本t检验。结果　心力衰竭组GDF-11、TSG-6水平均高于无心力衰竭组（均P<0.05）。两组性别、体质量指数（BMI）、合并基础疾病、吸烟史、饮酒史、收缩压、舒张压、三酰甘油（TG）、总胆固醇（TC）水平比较差异均无统计学意义（均P>0.05）。心力衰竭组年龄、心率（HR）、脑钠肽（BNP）、丙氨酸氨基转移酶（ALT）、血肌酐（Scr）水平高于无心力衰竭组，左心室射血分数（LVEF）水平低于无心力衰竭组（均P<0.05）。二元logistic回归分析结果显示，LVEF水平（OR=0.487，95%CI：0.289～0.818）是DCM患者发生心力衰竭的独立保护因素，BNP水平（OR=6.437，95%CI：1.793～23.104）、GDF-11水平（OR=3.582，95%CI：1.825～7.029）、TSG-6水平（OR=5.421，95%CI：2.329～12.617）是DCM患者发生心力衰竭的独立危险因素（均P<0.05）。ROC分析结果显示，GDF-11、TSG-6及二者联合预测DCM心力衰竭的灵敏度分别为72.60%、73.80%、90.50%，特异度分别为71.10%、75.60%、87.80%，曲线下面积（AUC）分别为0.794、0.818、0.948（均P<0.05）。GDF-11高表达患者与低表达患者KM曲线比较，差异有统计学意义（P<0.05）。TSG-6高表达患者与低表达患者KM曲线比较，差异有统计学意义（P<0.05）。结论　血清GDF-11、TSG-6与DCM患者心力衰竭风险相关，是影响患者发生心力衰竭的独立危险因素，临床通过联合检测GDF-11和TSG-6水平可较好地预测DCM患者心力衰竭发生情况。

关键词:

扩张型心肌病, 心力衰竭, 生长分化因子11, 肿瘤坏死因子α刺激基因-6

Abstract:

Objective　To explore the correlations between serum growth differentiation factor 11 (GDF-11) and tumor necrosis factor α-stimulating gene-6 (TSG-6) levels and the risk of heart failure in patients with dilated cardiomyopathy (DCM). Methods　A total of 174 patients with DCM admitted to the People's Hospital of Longhua, Shenzhen from August 2019 to May 2022 were retrospectively selected. There were 87 males and 87 females, aged 50 to 82 years. According to whether the patients were complicated with heart failure within 1 year, they were divided into a heart failure group (84 cases) and a non-heart failure group (90 cases). Serum GDF-11 and TSG-6 levels were measured in all the patients. The clinical data of the two groups were collected and were compared. Multivariate logistic regression analysis was used to analyze the influencing factors of heart failure in DCM patients. The predictive values of serum GDF-11 and TSG-6 levels for heart failure in DCM patients were analyzed by the receiver operating characteristic curve (ROC). Kaplan-Meier (KM) curve was used to analyze the correlations between GDF-11 and TSG-6 levels and heart failure. χ² test and independent sample t test were performed. Results　The levels of GDF-11 and TSG-6 in the heart failure group were higher than those in the non-heart failure group (both P<0.05). There were no statistically significant differences in the gender, body mass index (BMI), combined underlying diseases, smoking history, drinking history, systolic blood pressure, diastolic blood pressure, triglyceride (TG), or total cholesterol (TC) between the two groups (all P>0.05). The levels of age, heart rate (HR), brain natriuretic peptide (BNP), alanine aminotransferase (ALT), and serum creatinine (Scr) in the heart failure group were higher than those in the non-heart failure group, while the level of left ventricular ejection fraction (LVEF) was lower than that in the non-heart failure group (all P<0.05). Binary logistic regression analysis showed that LVEF level (OR=0.487, 95%CI: 0.289-0.818) was an independent protective factor for heart failure in DCM patients, and BNP (OR=6.437, 95%CI: 1.793-23.104), GDF-11 (OR=3.582, 95%CI: 1.825-7.029), and TSG-6 levels (OR=5.421, 95%CI: 2.329-12.617) were independent risk factors for heart failure in DCM patients (all P<0.05). ROC analysis results showed that the sensitivities of GDF-11, TSG-6, and their combination in predicting DCM heart failure were 72.60%, 73.80%, and 90.50%, the specificities were 71.10%, 75.60%, and 87.80%, and the areas under the curves were 0.794, 0.818, and 0.948, respectively (all P<0.05). There was a statistically significant difference in the KM curve between the patients with high expression of GDF-11 and the patients with low expression (P<0.05). There was a statistically significant difference in the KM curve between the patients with high expression of TSG-6 and the patients with low expression (P<0.05). Conclusions　Serum GDF-11 and TSG-6 are related to the risk of heart failure in DCM patients, and are independent risk factors affecting the occurrence of heart failure in DCM patients. The combined detection of GDF-11 and TSG-6 levels can better predict the occurrence of heart failure in DCM patients.

Key words:

Dilated cardiomyopathy, Heart failure, Growth differentiation factor 11, Tumor necrosis factor alpha stimulator gene-6

王稳苟志平谭钢文李欢.

血清GDF-11及TSG-6水平与扩张型心肌病患者心力衰竭风险的相关性 [J]. 国际医药卫生导报, 2024, 30(8): 1243-1248.

Wang Wen, Gou Zhiping, Tan Gangwen, Li Huan.

Correlations between serum GDF-11 and TSG-6 levels and risk of heart failure in patients with dilated cardiomyopathy [J]. International Medicine and Health Guidance News, 2024, 30(8): 1243-1248.

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