To discuss the expressions and clinical value of growth differentiation factor-15 (GDF-15), suppression of tumorigenicity-2 (ST-2) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF). Methods The patients (n=267) were chosen from Department of Cardiology in Shenzhen Hospital of University of Hong Kong from Feb. 2016 to Feb. 2018. All patients were divided, according to results of echocardiogram at hospitalization time, into HFpEF group (n=118) and HF-REF group (n=149). The levels of blood sugar, total cholesterol (TC), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C) and glycated hemoglobin (HbAlc) were detected in 2 groups. The content of GDF-15 and ST-2 were detected by using ELISA, and level of NT-proBNP was detected by using electro-chemiluminescence immunoassay (ECLIA). The left ventricular ejection fraction (LVEF), left atrial diameter (LAD), left ventricular end-diastolic inner diameter (LVEDd) and peak E mitral blood flow velocity/peak A mitral blood flow velocity (MVE/MVA) were recorded by using color Doppler ultrasonography. The diagnostic value of GDF-15, ST-2 and NT-proBNP to HFpEF was analyzed by using receiver operating characteristic (ROC) curve. Results ①The difference in indexes of blood sugar and blood fat had no statistical significance between 2 groups (all P>0.05) at hospitalization time. The levels of GDF-15, ST-2 and NT-proBNP were lower in HFpEF group than those in HFrEF group (P<0.05). ②LVEF was higher and other heart function indexes were lower in HFpEF group than those in HFrEF group (P<0.05). ③The results of multi-factor Logistic regression analysis showed that age, sex, GDF-15, ST-2, NT-proBNP and LVEF were independent impacting factors of (P<0.05). ④The results of ROC curve analysis showed that the area under ROC curve, sensitivity and specificity of integrated GDF-15, ST-2 and NT-proBNP in diagnosis were significantly higher than those of single diagnostic index (χ2=11.355, P<0.05). Conclusion The levels of GDF-15, ST-2 and NT-proBNP are closely correlated to LVEF, and they can be used as predictive factors in HFpEF patients.%目的 探讨生长转化因子15(GDF-15)、可溶性肿瘤形成抑制素2(ST-2)、N端脑钠肽前体(NT-proBNP)在左室射血分数保留或降低的心力衰竭(心衰)患者中的表达差异性以及其临床应用价值.方法 选取2016年2月至2018年2月于香港大学深圳医院心内科就诊的心衰患者267例为研究对象,依据入院时超声心动图检查结果分组.其中,左室射血分数保留的心衰(HFpEF)患者为HFpEF组(n=118),左室射血分数降低的心衰(HFrEF)患者为HFrEF组(n=149).测定两组患者实验室生化指标血糖、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、糖化血红蛋白(HbA1C);ELISA试剂盒测定患者血浆中GDF-15和ST-2含量;采用电化学发光法测定血液标本中 NT-proBNP水平;心脏彩色多普勒超声检查记录心功能指标左心室射血分数(LVEF)、左心房内径(LAD)、左心室舒张末期内径(LVDd)、二尖瓣血流E峰和A峰流速比值(MVE/MVA)等;并采用受试者工作特征(ROC)曲线分析GDF-15、ST-2、NT-proBNP对HFpEF的诊断价值.结果 ①入院时,两组患者血糖和血脂指标相比,差异均无统计学意义(P均＞0.05);HFpEF组患者外周血GDF-15、ST-2、NT-proBNP水平均低于HFrEF组患者,差异有统计学意义(P＜0.05).②HFpEF组患者LVEF高于HFrEF组患者,而其他心功能指标均低于HF-REF组患者,差异均具有统计学意义(P＜0.05).③经多因素Logistic回归分析,年龄、性别、GDF-15、ST-2、NT-proBNP和LVEF是HFpEF发生的独立影响因素(P＜0.05).④经ROC曲线分析,GDF-15、ST-2、NT-proBNP联合诊断的ROC曲线下的面积以及敏感度和特异度明显高于单独诊断指标(χ2=11.355,P＜0.05).结论 外周血GDF-15、ST-2、NT-proBNP水平与LVEF密切相关,可作为HFpEF患者的预测因子.
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