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生长分化因子-15(GDF-15)是术前心血管手术患者肌肉消耗和肾功能不全的生物标志物。

Growth Differentiation Factor-15 (GDF-15) is a Biomarker of Muscle Wasting and Renal Dysfunction in Preoperative Cardiovascular Surgery Patients.

作者信息

Nakajima Toshiaki, Shibasaki Ikuko, Sawaguchi Tatsuya, Haruyama Akiko, Kaneda Hiroyuki, Nakajima Takafumi, Hasegawa Takaaki, Arikawa Takuo, Obi Syotaro, Sakuma Masashi, Ogawa Hironaga, Toyoda Shigeru, Nakamura Fumitaka, Abe Shichiro, Fukuda Hirotsugu, Inoue Teruo

机构信息

Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan.

Department of Cardiovascular Surgery, School of Medicine, Dokkyo Medical University, Shimotsuga-gun, Tochigi 321-0293, Japan.

出版信息

J Clin Med. 2019 Oct 1;8(10):1576. doi: 10.3390/jcm8101576.

Abstract

Frailty and sarcopenia increase the risk of complications and mortality when invasive treatment such as cardiac surgery is performed. Growth differentiation factor-15 (GDF-15) involves various pathophysiological conditions including renal dysfunction, heart failure and cachexia. We investigated the pathophysiological roles of preoperative GDF-15 levels in cardiovascular surgery patients. Preoperative skeletal muscle index (SMI) determined by bioelectrical impedance analysis, hand-grip strength, 4 m gait speed, and anterior thigh muscle thickness (TMth) measured by echocardiography were assessed in 72 patients (average age 69.9 years) who underwent cardiovascular surgery. The preoperative serum GDF-15 concentration was determined by enzyme-linked immunosorbent assay. Circulating GDF-15 level was correlated with age, brain natriuretic peptide, and estimated glomerular filtration rate (eGFR). It was also negatively correlated with SMI, hand-grip strength, and anterior TMth. In multivariate analysis, eGFR and anterior TMth were the independent determinants of GDF-15 concentration even after adjusting for age, sex, and body mass index. Alternatively, the GDF-15 level was an independent determinant of eGFR and anterior TMth. We concluded that preoperative GDF-15 levels reflect muscle wasting as well as renal dysfunction in preoperative cardiovascular surgery patients. GDF-15 may be a novel biomarker for identify high-risk patients with muscle wasting and renal dysfunction before cardiovascular surgery.

摘要

在进行诸如心脏手术等侵入性治疗时,衰弱和肌肉减少症会增加并发症和死亡风险。生长分化因子-15(GDF-15)涉及多种病理生理状况,包括肾功能不全、心力衰竭和恶病质。我们研究了术前GDF-15水平在心血管手术患者中的病理生理作用。对72例接受心血管手术的患者(平均年龄69.9岁)进行了评估,通过生物电阻抗分析测定术前骨骼肌指数(SMI)、握力、4米步速,并通过超声心动图测量大腿前侧肌肉厚度(TMth)。术前血清GDF-15浓度通过酶联免疫吸附测定法测定。循环GDF-15水平与年龄、脑钠肽和估计肾小球滤过率(eGFR)相关。它也与SMI、握力和大腿前侧TMth呈负相关。在多变量分析中,即使在调整年龄、性别和体重指数后,eGFR和大腿前侧TMth仍是GDF-15浓度的独立决定因素。另外,GDF-15水平是eGFR和大腿前侧TMth的独立决定因素。我们得出结论,术前GDF-(此处原文有误,应为15)水平反映了术前心血管手术患者的肌肉消耗以及肾功能不全。GDF-15可能是一种新型生物标志物,用于识别心血管手术前肌肉消耗和肾功能不全的高危患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ffdd/6832285/b831f0ba4e9d/jcm-08-01576-g001.jpg

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