目的:测定心房颤动(AF)患者血清中生长分化因子-15(GDF-15)的浓度,研究GDF-15水平与包括基本临床信息在内的不同因素之间的相关性,生化检查,和心房结构,并进一步探讨GDF-15与AF类型和结构重塑之间的关联。
方法:前瞻性纳入2017年10月至2019年10月北京大学第三医院心内科病房收治的房颤患者。对照组纳入同时有窦性心律且无房颤史的患者。收集患者的临床信息和血液样本。酶联免疫吸附测定用于测量GDF-15的浓度。采用SPSS23.0进行统计分析。
结果:在研究中,纳入156例房颤患者(64例持续性房颤和92例阵发性房颤)和38例对照组。房颤组血清GDF-15水平明显高于对照组[1112(723,1525)ng/Lvs.697(499,825)ng/L,P<0.001]。持续性房颤组血清GDF-15水平明显高于阵发性房颤组[1140(858,1708)ng/Lvs.1090(662,1374)ng/L,P=0.047]。血清GDF-15水平预测房颤的曲线下面积(AUC)为0.736(95CI:0.651~0.822,P<0.001)。截断值为843.2ng/L,灵敏度为68.2%,特异性为78.9%。血清GDF-15水平预测持续性房颤的AUC为0.594(95CI:0.504-0.684,P=0.047)。截止值为771.5ng/L,灵敏度为82.8%,特异性为35.9%。Spearman等级相关分析显示,血清GDF-15水平与年龄呈正相关(r=0.480,P<0.001)。左心房压(LAP,r=0.300,P<0.001),也与左心耳流速呈负相关(LAAV,r=-0.252,P=0.002)。多元线性回归分析显示,年龄和LAP对GDF-15水平有显著影响(P<0.05)。Logistic回归分析提示GDF-15(OR=1.002,95CI:1.001-1.003,P=0.004)和左心房内径(LAD,OR=1.400,95CI:1.214-1.616,P<0.001)是房颤的独立预测因子。
结论:房颤患者血清GDF-15水平较高。同时,持续性房颤患者的血清GDF-15水平高于阵发性房颤患者。GDF-15与AF和心房结构重构相关。
OBJECTIVE: To measure the concentration of growth differentiation factor-15 (GDF-15) in the serum of patients with atrial fibrillation (AF), to study the correlations between the levels of GDF-15 and different factors including basic clinical information, biochemical examinations, and atrial structure, and further to explore the association between GDF-15 and AF types and structural remodeling.
METHODS: AF patients who were admitted to the ward of the Department of Cardiology at Peking University Third Hospital between October 2017 and October 2019 were prospectively enrolled. Patients admitted to the ward at the same time with sinus rhythm and no prior AF history were enrolled in the control group. Clinical information and blood samples of the patients were collected. Enzyme-linked immunosorbent assay was used to measure the concentration of GDF-15. SPSS 23.0 was used for statistical analysis.
RESULTS: In the study, 156 AF patients (64 persistent AF and 92 paroxysmal AF) and 38 patients of the control group were included. Serum GDF-15 levels in the AF group were significantly higher than in the control group [1 112 (723, 1 525) ng/L vs. 697 (499, 825) ng/L, P < 0.001]. Serum GDF-15 levels in the persistent AF group were significantly higher than in the paroxysmal AF group [1 140 (858, 1 708) ng/L vs. 1 090 (662, 1 374) ng/L, P=0.047]. The area under the curve (AUC) of serum GDF-15 levels for prediction of AF was 0.736 (95%CI: 0.651-0.822, P < 0.001). The cut-off value was 843.2 ng/L with a sensitivity of 68.2% and a specificity of 78.9%. The AUC of serum GDF-15 levels for prediction of persistent AF was 0.594 (95%CI: 0.504-0.684, P=0.047). The cut-off va-lue was 771.5 ng/L with a sensitivity of 82.8% and a specificity of 35.9%. Spearman rank correlation analysis showed that the serum GDF-15 levels were positively correlated with age (r=0.480, P < 0.001), left atrial pressure (LAP, r=0.300, P < 0.001), and also negatively correlated with left atrial appendage flow velocity (LAAV, r=-0.252, P=0.002). Multiple linear regression analysis showed that age and LAP affected the GDF-15 levels significantly (P < 0.05). Logistic regression analysis suggested GDF-15 (OR=1.002, 95%CI: 1.001-1.003, P=0.004) and left atrial diameter (LAD, OR=1.400, 95%CI: 1.214-1.616, P < 0.001) were independent predictors of AF.
CONCLUSIONS: Serum GDF-15 levels are higher in AF patients. Meanwhile, serum GDF-15 levels are higher in persistent AF patients than paroxysmal AF patients. GDF-15 is associated with AF and atrial structural remodeling.