血清N末端B型脑钠肽前体与磷脂酰肌醇蛋白聚糖-6联合应用于心力衰竭的诊断
Combined Use of Serum N-terminal Pro-B-Type Natriuretic Peptide and Glypican-6 in the Diagnosis of Heart Failure.
作者信息
Sağlam Emre Cem, Yadigaroğlu Metin, Güzel Murat, Turan Hatice, Hakan Aksu Şakir, Ocak Metin, Gorgun Selim, Arslan Uğur, Yücel Murat
机构信息
Emergency Medicine, Sadıka Sabancı State Hospital, Sakarya, TUR.
Emergency Medicine, Samsun University Faculty of Medicine, Samsun, TUR.
出版信息
Cureus. 2023 Sep 22;15(9):e45766. doi: 10.7759/cureus.45766. eCollection 2023 Sep.
OBJECTIVE
The aim of this study was to investigate the efficacy of serum glypican-6 (GPC-6) levels and the combination of N-terminal pro-B-type natriuretic peptide (NT-ProBNP) and GPC-6 in the diagnosis of heart failure (HF).
METHODS
In this prospective study, patients older than 18 years of age, admitted to the emergency department of our hospital between December 2021 and April 2022, diagnosed with heart failure (patient group), and healthy volunteers with similar sociodemographic characteristics (control group) were included. The disease severity classification of the patient group was made according to the 2021 ESC guidelines, using echocardiographic findings. Serum GPC-6 and NT-ProBNP levels were measured by the enzyme-linked immunosorbent assay (ELISA) method, which determines the antigen-antibody relationship. Optimal GPC-6 and NT-ProBNP levels for the diagnosis of HF were determined by receiver operating characteristic (ROC) analysis. The patients were divided into three groups according to these levels. Group 1 consisted of patients with both markers below the cutoff values, Group 2 consisted of patients with either of these markers above the cutoff values, and Group 3 consisted of patients with both markers above the cutoff values.
RESULTS
The study included 65 heart failure patients and 20 healthy volunteers. When the patient and control groups were compared in terms of serum GPC-6 and serum NT-ProBNP levels, both parameters were evaluated as significantly higher in the patient group (p=0.038 and p<0.001; respectively). In the ROC analysis, it was determined that GPC-6 indicated HF with 58.46% sensitivity and 75% specificity for an optimal cutoff value of 390 pg/ml. In the ROC analysis, it was determined that serum NT-ProBNP indicated HF with 89.23% sensitivity and 70% specificity for an optimal cutoff value of 122 pg/ml. When the groups were compared according to the rate of HF, it was found to be higher in Group 3 compared to Group 2 (97.1% vs. 70.3%, p<0.002) and Group 1 (97.1% vs. 38.5%, p<0.001). This rate was seen to be significantly higher in Group 2 compared to Group 1 (70.3% vs. 38.5%, p=0.042).
CONCLUSION
The combination of GPC-6 and NT-ProBNP may help diagnose HF patients admitted to the emergency department.
目的
本研究旨在探讨血清磷脂酰肌醇蛋白聚糖-6（GPC-6）水平以及N端前脑钠肽（NT-ProBNP）与GPC-6联合检测在心力衰竭（HF）诊断中的效能。
方法
在这项前瞻性研究中，纳入了2021年12月至2022年4月期间入住我院急诊科、年龄大于18岁、诊断为心力衰竭的患者（患者组）以及具有相似社会人口学特征的健康志愿者（对照组）。根据2021年欧洲心脏病学会（ESC）指南，利用超声心动图检查结果对患者组进行疾病严重程度分级。采用酶联免疫吸附测定（ELISA）法测定血清GPC-6和NT-ProBNP水平，该方法可确定抗原-抗体关系。通过受试者工作特征（ROC）分析确定诊断HF的最佳GPC-6和NT-ProBNP水平。根据这些水平将患者分为三组。第1组由两种标志物水平均低于临界值的患者组成，第2组由其中一种标志物水平高于临界值的患者组成，第3组由两种标志物水平均高于临界值的患者组成。
结果
该研究纳入了65例心力衰竭患者和20例健康志愿者。比较患者组和对照组的血清GPC-6和血清NT-ProBNP水平时，发现患者组这两个参数均显著更高（分别为p = 0.038和p < 0.001）。在ROC分析中，确定GPC-6诊断HF的最佳临界值为390 pg/ml时，敏感性为58.46%，特异性为75%。在ROC分析中，确定血清NT-ProBNP诊断HF的最佳临界值为122 pg/ml时，敏感性为89.23%，特异性为70%。比较各组的HF发生率时，发现第3组高于第2组（97.1%对70.3%，p < 0.002）和第1组（97.1%对38.5%，p < 0.001）。第2组的该发生率显著高于第1组（70.3%对38.5%，p = 0.042）。
结论
GPC-6与NT-ProBNP联合检测可能有助于急诊科收治的HF患者的诊断。
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