生长分化因子-15作为ST段抬高型心肌梗死中冠状动脉微血管功能障碍的生物标志物。
Growth differentiation factor-15 as a biomarker of coronary microvascular dysfunction in ST-segment elevation myocardial infarction.
作者信息
Tian Rui, Wang Zerui, Zhang Shenglin, Wang Xiaojun, Zhang Yiwen, Yuan Jiaquan, Zhang Jiajun, Xu Feng, Chen Yuguo, Li Chuanbao
机构信息
Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan ,250012, China.
Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan ,250012, China.
出版信息
Heliyon. 2024 Jul 30;10(15):e35476. doi: 10.1016/j.heliyon.2024.e35476. eCollection 2024 Aug 15.
BACKGROUND
The predictive value of growth differentiation factor-15 (GDF-15) in coronary microvascular dysfunction (CMD) following primary percutaneous coronary intervention (PPCI) in ST-segment elevation myocardial infarction (STEMI) patients is unclear.
METHODS
This study continuously recruited STEMI patients treated with PPCI at the Chest Pain Center of Qilu Hospital of Shandong University from April 2023 to December 2023. Blood samples were taken before PPCI and the level of circulating GDF-15 was measured by enzyme-linked immunosorbent assay (ELISA), and the patients were divided into CMD and Control group according to angiographic microvascular resistance (AMR) (cut-off value 2.50 mmHg*s/cm). The differences in GDF-15 expression levels between the two groups were compared, and the predictive value of GDF-15 for CMD was systematically evaluated.
RESULTS
A total of 134 patients, with an average age of 59.78 ± 12.69 years and 75.37 % being male, were included in this study. Multivariable logistic regression revealed a significant association between GDF-15 and CMD (adjusted OR = 2.505, 95 % CI: 1.661-3.779, < 0.001). The area under the curve (AUC) of GDF-15 for CMD was 0.782 (95 % CI: 0.704-0.861), with a sensitivity of 0.795 and specificity of 0.643 in predicting CMD in PPCI. The AUC of the GDF-15 model (Model With GDF-15) was 0.867 (95 % CI: 0.806-0.928), significantly outperforming the clinical baseline model (Model Without GDF-15) (Δ AUC = 0.079, 95 % CI: 0.020-0.138, = 0.009). Furthermore, the net reclassification improvement (NRI) was 0.854 (95 % CI: 0.543-1.166, < 0.001), and the integrated discrimination improvement (IDI) was 0.151 (95 % CI: 0.089-0.213, < 0.001).
CONCLUSIONS
GDF-15 can serve as a biomarker for predicting the development of CMD in STEMI patients undergoing PPCI.
背景
生长分化因子15（GDF-15）在ST段抬高型心肌梗死（STEMI）患者接受直接经皮冠状动脉介入治疗（PPCI）后冠状动脉微血管功能障碍（CMD）中的预测价值尚不清楚。
方法
本研究连续纳入2023年4月至2023年12月在山东大学齐鲁医院胸痛中心接受PPCI治疗的STEMI患者。在PPCI前采集血样，采用酶联免疫吸附测定（ELISA）法检测循环GDF-15水平，并根据血管造影微血管阻力（AMR）（临界值2.50mmHg*s/cm）将患者分为CMD组和对照组。比较两组GDF-15表达水平的差异，并系统评估GDF-15对CMD的预测价值。
结果
本研究共纳入134例患者，平均年龄59.78±12.69岁，男性占75.37%。多变量逻辑回归显示GDF-15与CMD之间存在显著关联（调整后的OR=2.505，95%CI：1.661-3.779，<0.001）。GDF-15对CMD的曲线下面积（AUC）为0.782（95%CI：0.704-0.861），在预测PPCI患者的CMD方面，敏感性为0.795，特异性为0.643。GDF-15模型（含GDF-15模型）的AUC为0.867（95%CI：0.806-0.928），显著优于临床基线模型（不含GDF-15模型）（ΔAUC=0.079，95%CI：0.020-0.138，=0.009）。此外，净重新分类改善（NRI）为0.854（95%CI：0.543-1.166，<0.001），综合判别改善（IDI）为0.151（95%CI：0.089-0.213，<0.001）。
结论
GDF-15可作为预测接受PPCI的STEMI患者发生CMD的生物标志物。
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