心肺复苏患者血清GDF-15、NT-proBNP、cTnI水平变化的临床意义及其与近期预后的关系
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(承德市中心医院 1.急诊科,;2.重症医学二病区,河北省承德市 067000)

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于海侠,硕士,副主任医师,研究方向为急危重症的救治,E-mail为haixiayuer@163.com。

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承德市科学技术研究与发展计划项目(20142009)


Clinical significance of changes of serum GDF-15, NT-proBNP and cTnI levels and its relationship with short-term prognosis in patients with cardiopulmonary resuscitation
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1.Department of Emergency, ;2.Department of ICU, Central Hospital of Chengde City, Chengde, Hebei 067000, China)

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    摘要:

    目的 探讨心脏骤停心肺复苏(CPR)成功后的患者血清生长分化因子15(GDF-15)、N端B型利钠肽原(NT-proBNP)、心肌肌钙蛋白I(cTnI)不同时间水平变化的临床意义及与近期预后的关系。方法 分别检测102例CPR患者CPR后即刻、12 h、24~48 h的血清GDF-15水平,根据血清GDF-15升高时间分为3组:(1)A组:CPR后即刻、12 h、24~48 h GDF-15水平一直小于1200 ng/L;(2)B组:CPR后12 h 和24~48 h GDF-15水平均升高,且大于1200 ng/L;(3)C组:CPR后即刻和12 h GDF-15水平升高,24~48 h GDF-15水平较12 h时降低。同时检测3组患者各时间点血清NT-proBNP、cTnI水平及左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)。随访3组患者CPR后6个月的死亡情况。结果 GDF-15与NT-proBNP、cTnI具有交互作用(P=0.001)。LVEDD、LVEF随着GDF-15、NT-proBNP、cTnI水平的变化而变化。GDF-15、NT-proBNP、cTnI高水平组患者死亡率均高于GDF-15、NT-proBNP、cTnI低水平组(P<0.05)。生存率分析结果显示,6个月生存率A组高于B组(χ2=12.738,P=0.001),B组较C组低(χ2=7.253,P=0.009),A组和C组无显著差异(χ2=2.240,P=0.097)。结论 血清GDF-15、NT-proBNP、cTnI水平是预测CPR患者近期预后的很好指标,联合检测意义更大。

    Abstract:

    Aim To investigate the clinical significance of serum growth differentiation factor 15 (GDF-15), N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI) changes at different time and its relationship with short-term prognosis in patients with cardiac arrest cardiopulmonary resuscitation. Methods The serum levels of GDF-15 were detected in 102 CPR patients at instant time, 12 h, 24-48 h after CPR. According to the rise time of serum GDF-15, the patients were divided into 3 groups:(1)A group:at instant time, 12 h, 24-48 h after CPR, GDF-15 levels had been less than 1200 ng/L; (2)B group:at 12 h and 24-48 h after CPR, GDF-15 levels were increased, and more than 1200 ng/L; (3)C group:at instant time, 12 h after CPR, GDF-15 levels were increased, but GDF-15 level at 24-48 h was lower than that at 12 h. At each time point, the serum levels of NT-proBNP and cTnI, left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) were detected at the same time in 3 groups. The death situation of 3 groups was followed up for 6 months after CPR. Results GDF-15 had an interaction with NT-proBNP and cTnI (P=0.001). LVEDD and LVEF were changed with the changes of GDF-15, NT-proBNP and cTnI levels. The mortality rates of patients in GDF-15, NT-proBNP and cTnI high level groups were higher than those in GDF-15, NT-proBNP and cTnI low level groups (P<0.05). Survival analysis results showed that the 6 month survival rate of A group was higher than that of B group (χ2=12.738, P=0.001), the 6 month survival rate of B group was lower than that of C group (χ2=7.253, P=0.009), and there was no significant difference in 6 month survival rate between A group and C group (χ2=2.240, P=0.097). Conclusion The serum levels of GDF-15, NT-proBNP and cTnI are good indicators for predicting the short-term prognosis of CPR patients, and the significance of combined detection is even higher.

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于海侠,周景霞,任长安,武会志,李忠,刘春涛.心肺复苏患者血清GDF-15、NT-proBNP、cTnI水平变化的临床意义及其与近期预后的关系[J].中国动脉硬化杂志,2017,25(3):269~273.

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  • 收稿日期:2016-07-24
  • 最后修改日期:2016-09-03
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  • 在线发布日期: 2017-03-28