血清GDF-15、NT-proBNP、CRP水平与冠心病合并糖尿病患者左心室重构的关系

Relationship between Serum Levels of GDF-15, NT-proBNP, CRP and Left Ventricular Remodeling in Patients with Coronary Heart Disease and Diabetes

摘要: 目的：分析探讨血清生长分化因子15 (GDF-15)、N端脑钠肽前体(NT-proBNP)、C反应蛋白(CRP)水平与冠心病合并糖尿病患者左心室重构(LVR)的关系。方法：选取2021年~2023年内蒙古自治区人民医院心血管内科收治的冠心病合并糖尿病患者198例，根据随访3个月时左心室舒张末期容积(LVEDV)分为LVR组104例和非LVR组94例。两组均进行血清学检测及超声心动图检测。比较两组患者血清GDF-15、NT-proBNP、CRP的表达水平，以及左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、舒张末期室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左室收缩末期内径(LVESD)、左室质量(LVM)及左心室质量指数(LVMI)水平。行Spearman等级相关分析两组患者血清GDF-15、NT-proBNP、CRP的表达水平与LVEF、LVEDD、LVESD、LVM、LVMI之间的关系。受试者工作特征曲线(ROC)分析血清GDF-15、NT-proBNP、CRP表达对冠心病合并糖尿病患者心室重构的预测价值。结果：LVR组血清GDF-15、NT-proBNP、CRP表达水平高于非LVR组，差异具有统计学意义(P < 0.001)；LVR组LVEDD、LVESD、LVM、LVMI水平均高于非心室重构组，LVEF水平低于非LVR组，差异具有统计学意义(P < 0.001)。Pearson系数分析结果显示，血清中GDF-15、NT-proBNP及CRP水平与心室重构指标LVEDD、LVESD、LVM、LVMI呈正相关关系，与心室重构指标LVEF呈负相关关系(P < 0.001)。ROC曲线分析显示，血清GDF-15、NT-proBNP、CRP及三者联合预测冠心病合并糖尿病患者心室重构的曲线下面积分别为0.879、0.971、0.959、0.974，三者联合预测的价值高于单项指标。结论：冠心病合并糖尿病患者血清GDF-15、NT-proBNP、CRP水平与心室重构相关，可作为冠心病合并糖尿病患者预后不良的辅助预测指标，为其临床诊疗、监测和预后评估等提供参考。

Abstract: Objective: To analyze the relationship between serum levels of growth differentiation factor 15 (GDF-15), N-terminal pro brain natriuretic peptide (NT-proBNP), C-reactive protein (CRP) and left ventricular remodeling (LVR) in patients with coronary heart disease and diabetes. Methods: 198 patients with coronary heart disease and diabetes admitted to the Department of Cardiology of the People’s Hospital of Inner Mongolia Autonomous Region from 2021 to 2023 were selected. According to the left ventricular end diastolic volume (LVEDV) at 3 months of follow-up, they were divided into 104 patients in the LVR group and 94 patients in the non LVR group. Both groups underwent serological and echocardiography tests. We compare the expression levels of serum GDF-15, NT-proBNP, CRP, as well as left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), end diastolic interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular end systolic diameter (LVESD), left ventricular mass (LVM), and left ventricular mass index (LVMI) between two groups of patients. Perform Spearman rank correlation analysis on the relationship between the expression levels of serum GDF-15, NT-proBNP, CRP and LVEF, LVEDD, LVESD, LVM, and LVMI in two groups of patients. The predictive value of serum GDF-15, NT-proBNP, CRP expression on ventricular remodeling in patients with coronary heart disease and diabetes was analyzed by receiver operating characteristic curve (ROC). The expression levels of serum GDF-15, NT-proBNP, and CRP in the LVR group were higher than those in the non LVR group, and the differences were statistically significant (P < 0.001); The LVEDD, LVESD, LVM, and LVMI levels in the LVR group were higher than those in the non ventricular remodeling group, while the LVEF levels were lower than those in the non LVR group, with statistical significance (P < 0.001). The Pearson coefficient analysis results showed that the levels of GDF-15, NT-proBNP, and CRP in serum were positively correlated with the ventricular remodeling indicators LVEDD, LVESD, LVM, and LVMI, and negatively correlated with the ventricular remodeling indicator LVEF (P < 0.001). ROC curve analysis showed that the area under the curve of serum GDF-15, NT-proBNP, CRP and their combined prediction of ventricular remodeling in patients with coronary heart disease and diabetes was 0.879, 0.971, 0.959, 0.974, respectively, and their combined prediction value was higher than that of single index. Conclusion: The serum levels of GDF-15, NT-proBNP and CRP in patients with coronary heart disease and diabetes are related to ventricular remodeling, which can be used as an auxiliary predictor of poor prognosis in patients with coronary heart disease and diabetes, and provide reference for clinical diagnosis, treatment, monitoring and prognosis evaluation.