本文選題：GDF-15 + GRACE評分��； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:研究人生長分化因子-15(Growth Differentiation Factor-15,GDF-15)及其聯(lián)合全球急性冠狀動脈事件注冊(Global Registry of Acute Coronary Events,GRACE)風(fēng)險評分對非ST段抬高型急性冠狀動脈綜合征(Non-ST elevated acute coronary syndrome,NSTE-ACS)患者的預(yù)后價值。方法:收集池州市人民醫(yī)院2015年6月-2016年6月經(jīng)冠狀動脈造影證實是NSTE-ACS的住院患者73例作為實驗組,同期經(jīng)冠狀動脈造影證實無冠脈病變的37例住院病人作為正常對照組,兩組在性別、身高、年齡、體重等方面相匹配。運用酶聯(lián)免疫吸附試驗(Enzyme-Linked Immunosorbent Assay,ELISA)檢測入院時的血清GDF-15水平,同時計算實驗組的GRACE評分,比較實驗組與對照組的血清GDF-15水平及GRACE評分大小。氨基末端腦鈉素前體(N-terminal pro-brain natriuretic peptide,NTpro BNP)是離散型變量,對NTpro BNP取自然對數(shù)后符合正態(tài)分布,比較兩組間NTpro BNP的自然對數(shù)值(In NTpro BNP)、左室射血分數(shù)(Left ventricular ejection fraction,LVEF)以及其他臨床基礎(chǔ)資料和血液生化資料的差異。運用Pearson相關(guān)性分析法分析血清GDF-15水平與NSTE-ACS患者GRACE評分、In NTpro BNP及LVEF等臨床生化資料的相關(guān)性。對NSTE-ACS患者隨訪半年,記錄半年內(nèi)發(fā)生的主要不良心血管事件(Major adverse cardiovascular event,MACE)。結(jié)果:(1)NSTE-ACS患者組與對照組一般計量資料的比較:本研究共納入110例住院患者,其中NSTE-ACS患者組(包括非ST抬高型心肌梗死患者及不穩(wěn)定心絞痛患者)共73人,正常對照組37人。NSTE-ACS患者組與對照組在年齡、心率、收縮壓(Systolic Blood Pressure,SBP)、總膽固醇(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、血紅蛋白等一般計量資料差異無統(tǒng)計學(xué)意義(P0.05)。NSTE-ACS患者組LVEF明顯低于患者組,NSTE-ACS患者組In NT-pro BNP、血清肌酐(Serum Creatinine,SCr)、血清GDF-15水平、明顯高于對照組,差異有統(tǒng)計學(xué)意義(P0.01)。其中對NSTE-ACS組患者進行GRACE風(fēng)險評分,結(jié)果為(100.720±23.790)分。(2)NSTE-ACS患者組與對照組一般計數(shù)資料比較:本研究中共有68例患者的心電圖上存在ST段改變,其中NSTE-ACS患者組51例,對照組17例,NSTE-ACS患者組ST段改變患者、有吸煙史等人數(shù)比例較對照組明顯升高,差異均有統(tǒng)計學(xué)意義(P0.05)。NSTE-ACS患者組中有飲酒史、糖尿病(diabetes mellitus,DM)史、有冠心病史人數(shù)比例、有心肌標(biāo)志物升高患者比例以及男性患者比例較對照組差異無明顯統(tǒng)計學(xué)意義(P0.05)。(3)NSTE-ACS患者組血清GDF-15水平與血液生化指標(biāo)及臨床基礎(chǔ)資料相關(guān)性分析:Pearson相關(guān)性分析顯示NSTE-ACS患者血清GDF-15水平與GRACE風(fēng)險評分(r=0.576,P0.001)、In NTpro BNP(r=0.602,P0.001)、肌酐(r=0.286,P=0.003)均呈正相關(guān)。血清GDF-15水平與左室射血分數(shù)呈顯著負相關(guān)(r=-0.608,P0.001)。血清GDF-15水平與NSTE-ACS患者TC、TG、HDL、LDL、血紅蛋白無明顯相關(guān)性(P0.05)。(4)血清GDF-15水平、GRACE評分及兩者聯(lián)合對NSTE-ACS患者預(yù)后的診斷價值評估:本研究對NSTE-ACS患者隨訪半年,記錄其半年內(nèi)發(fā)生的不良心血管事件數(shù),共有73例NSTE-ACS患者完成了隨訪,共發(fā)生MACE事件26例,其中心源性死亡1例,再發(fā)心衰1例,再發(fā)心肌梗死1例,再發(fā)心絞痛23例,由受試者操作特征曲線(Receiver Operating Characteristic curve,ROC曲線)分析得出血清GDF-15水平預(yù)測NSTE-ACS患者MACE的曲線下面積0.862,(95%CI:0.773,0.951);敏感度84.60%,特異度85.10%。GRACE評分預(yù)測NSTE-ACS患者MACE的曲線下面積0.813,(95%CI:0.712,0.914);敏感度69.20%,特異度85.10%。血清GDF-15水平聯(lián)合GRACE評分預(yù)測NSTE-ACS患者MACE的曲線下面積由血清GDF-15水平的0.862增加到0.873(95%CI:0.790,0.956),P0.05,差異有統(tǒng)計學(xué)意義。(5)單因素及多因素logistic回歸分析:定義NSTE-ACS患者出現(xiàn)MACE為因變量,將可能影響NSTE-ACS患者預(yù)后的變量納入單因素及多因素logistic回歸分析,結(jié)果提示血清GDF-15水平、GRACE評分、In NT-pro BNP、LVEF、年齡、ST段改變?yōu)镹STE-ACS患者預(yù)后的危險因素(P0.05),其中血清GDF-15水平為校正其他危險因素后NSTE-ACS患者短期預(yù)后的獨立危險因素(P0.05)。結(jié)論:1.NSTE-ACS患者血清GDF-15水平與GRACE評分呈正相關(guān);2.血清GDF-15水平對NSTE-ACS患者預(yù)后有較高的診斷價值;3.聯(lián)合血清GDF-15水平與GRACE評分可增加血清GDF-15水平或GRACE評分對NSTE-ACS患者預(yù)后的診斷價值;4.血清GDF-15水平是校正其他危險因素后NSTE-ACS患者預(yù)后的獨立危險因素。
[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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4

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本文編號：1968857