血清GDF-15、cTNI 联合检测与心肺复苏患者心功能及其近期预后的关系

Changes of serum GDF-15 and cTNI after cardiopulmonary resuscitation and recent clinical prognosis

摘要:

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）、肌钙蛋白Ⅰ（cTNI）不同时间的水平变化及其与心功能、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，A 组：CPR 后即刻、12 h、24～48 h血清GDF-15水平持续<1200ng/L；B组：CPR后12h和24～48h GDF-15水平持续升高，且持续>1 200 ng/L；C组：CPR 后12 h和24～48 h GDF-15 水平持续升高，但24～48 h较12 h降低。同时检测3 组患者各时间血清cTNI 水平，并测定各时间左心室舒张末内径（LVEDD），左室射血分数（LVEF），随访3 组患者CPR 后6 个月的死亡情况。结果GDF-15 和cTNI 水平具有交互作用（p <0.05），即cTNI 表达水平随着血清GDF-15 的变化而变化。同时发现，LVEDD和LVEF随着GDF-15 和cTNI 水平的变化而变化。B 组死亡率高于A组和C组（p <0.05），A 组死亡率与C 组比较，差异无统计学意义（p >0.05）；随访6 个月结果显示，B 组患者生存率低于A组和C 组（p <0.05），A 组与C 组比较，差异无统计学意义（p >0.05）。GDF-15 高水平组（>1 800 ng/L）、cTNI 高水平组（>1.5 ng/ml）患者死亡率均高于GDF-15、cTNI 低水平组（p <0.05）。结论血清GDF-15 与cTNI联合检测有望成为预测CPR 患者近期预后的良好指标。

Abstract:

To explore the changes of serum levels of growth defferentiation factor-15 (GDF-15) and troponin Ⅰ(cTNI) at different time after successful cardiopulmonary resuscitation (CPR) and their relationships with cardiac function and the recent clinical prognosis of CPR. Methods A total of 102 victims who received CPR for sudden cardiac arrest were divided into three groups. The victims whose GDF-15 level was under 1,200 ng/L were enrolled into group A; those whose GDF-15 level continued to increase 12 h and 24-48 h after CPR and was over 1,200 ng/L were included into group B; and group C included those whose GDF-15 level increased 12 h after CPR but was lowered 24-48 h after CPR. Serum cTNI, left vetricle enddiastolic diameter (LVEDD), left ventricle ejection fraction (LVEF) were detected in the three groups at different time. The patients were followed up for 6 m and the mortality was calculated. Results The cTNI level changed with the change of GDF-15. LVEDD and LVEF also changed with the changes of GDF-15 and cTnI levels. The mortality of the group B was obviously higher than that of the group A and the group C (p < 0.05). The mortality of the group C was slightly higher than that of the group A (p > 0.05). ConclusionsThe joint detection of serum GDF-15 and cTNI can well predict the recent clinical outcomes of the patients receiving CPR.