Xu B D, Chen K, Liu Y H, Su W T, Ye T, Wu G Y, Zong G J
Department of Cardiologyg, the 904th Hospital of Joint Logistic Support Force of People's Liberation Army of China, Wuxi 214000, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2024 Mar 24;52(3):286-292. doi: 10.3760/cma.j.cn112148-20230715-00005.
To investigate the correlation between serum growth differentiation factor 11 (GDF11) level and coronary artery lesions in patients with ST-segment elevation myocardial infarction (STEMI), and the predictive efficacy of nomogram risk prediction model based on GDF11 combined with traditional risk factors on the occurrence of STEMI. This study was a retrospective cross-sectional study. Patients hospitalized in the Department of Cardiology of the 904th Hospital of Joint Logistic Support Force of People's Liberation Army of China from 2016 to 2018 were selected and divided into control group and STEMI group. The demographic data, blood lipid level, laboratory indicators of blood and GDF11 level were collected. Logistic regression analysis screened out independent correlated factors for the occurrence of STEMI. Spearman correlation analysis clarified the correlation of each indicator with the SYNTAX or Gensini scores. A nomogram risk prediction model for the risk of STEMI occurrence and the receiver operating characteristic curve was used to compare the prediction efficiency of each model. A total of 367 patients were enrolled, divided into control group (=172) and STEMI group (=195), age (66.5±11.8), male 222 (60.49%). The serum GDF11 level of STEMI group was significantly lower than that of the control group (36.20 (16.60, 70.75) μg/L vs. 85.00 (53.93, 117.10) μg/L, <0.001). The results of multivariate logistic regression analysis showed serum GDF11(0.98, 95%: 0.97-0.99) and traditional independent risk factors such as smoking, diabetes, C-reactive protein, homocysteine, lipoprotein (a) and apolipoprotein A1/B were independent correlate factors for the occurrence of STEMI (<0.05). Spearman correlation analysis showed that serum GDF11 was negatively correlated with SYNTAX score and Gensini score (<0.05). The nomogram model constructed by serum GDF11 combined with traditional independent risk factors (AUC=0.85, 95%: 0.81-0.89) had better predictive value for the occurrence of STEMI than the traditional nomogram model constructed by independent risk factors(AUC=0.80, 95%:0.75-0.84) or serum GDF11 (AUC=0.76, 95%: 0.72-0.81), all <0.01. Serum GDF11 is an independent correlate factor in the occurrence of STEMI and is negatively correlated with the severity of coronary artery lesions in patients with STEMI. The nomogram model constructed based on GDF11 combined with traditional risk factors can be a good predictor for the occurrence of STEMI.
探讨血清生长分化因子11（GDF11）水平与ST段抬高型心肌梗死（STEMI）患者冠状动脉病变的相关性，以及基于GDF11联合传统危险因素的列线图风险预测模型对STEMI发生的预测效能。本研究为回顾性横断面研究。选取2016年至2018年在中国人民解放军联勤保障部队第904医院心内科住院的患者，分为对照组和STEMI组。收集人口统计学数据、血脂水平、血液实验室指标及GDF11水平。采用Logistic回归分析筛选出STEMI发生的独立相关因素。Spearman相关性分析明确各指标与SYNTAX或Gensini评分的相关性。采用STEMI发生风险的列线图风险预测模型及受试者工作特征曲线比较各模型的预测效率。共纳入367例患者，分为对照组（n = 172）和STEMI组（n = 195），年龄（66.5±11.8）岁，男性222例（60.49%）。STEMI组血清GDF11水平显著低于对照组（36.20（16.60，70.75）μg/L vs. 85.00（53.93，117.10）μg/L，P<0.001）。多因素Logistic回归分析结果显示，血清GDF11（OR = 0.98，95%CI：0.97 - 0.99）以及吸烟、糖尿病、C反应蛋白、同型半胱氨酸、脂蛋白（a）和载脂蛋白A1/B等传统独立危险因素是STEMI发生的独立相关因素（P<0.05）。Spearman相关性分析显示，血清GDF11与SYNTAX评分和Gensini评分呈负相关（P<0.05）。血清GDF11联合传统独立危险因素构建的列线图模型（AUC = 0.85，95%CI：0.81 - 0.89）对STEMI发生的预测价值优于独立危险因素构建的传统列线图模型（AUC = 0.80，95%CI：0.75 - 0.84）或血清GDF11（AUC = 0.76，95%CI：0.72 - 0.81），差异均有统计学意义（P<0.01）。血清GDF11是STEMI发生的独立相关因素，且与STEMI患者冠状动脉病变严重程度呈负相关。基于GDF11联合传统危险因素构建的列线图模型可较好地预测STEMI的发生。
