扩张性心肌病血清转化生长因子β与生长分化因子15的变化及意义
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摘要
目的探讨扩张性心肌病患者血清转化生长因子β(TGF-β)与生长分化因子15(GDF-15)的变化及意义。方法研究对象为本院收治的168例扩张性心肌病患者,根据美国纽约心脏病学会(NYHA)心功能分级分为Ⅰ级21例、Ⅱ级45例,Ⅲ级52例,Ⅳ级50例。于治疗前取空腹肘静脉血,采用ELISA实验检测血清TGF-β和GDF-15水平,并分析两者与心室结构、心功能及预后的关系。结果各组患者心室结构、心功能和血清TGF-β、GDF-15水平明显不同,与Ⅰ级相比,Ⅱ级、Ⅲ级、Ⅳ级LVEDV和LVESV增大,LVEF和CO减小,TGF-β和GDF-15水平升高;与Ⅱ级相比,Ⅲ级、Ⅳ级LVEDV和LVESV增大,LVEF和CO减小,TGF-β和GDF-15水平升高;与Ⅲ级相比,Ⅳ级LVEDV和LVESV增大,LVEF和CO减小,TGF-β和GDF-15水平升高;差异均有统计学意义(P<0.05)。Ⅳ级患者的心力衰竭发生率和死亡率均高于Ⅰ级与Ⅱ级患者,差异有统计学意义(P<0.05)。血清TGF-β和GDF-15水平与LVEDV、LVESV有正相关性,与LVEF、CO呈负相关,且对心力衰竭具有较高的预测价值(P<0.05)。结论 TGF-β和GDF-15在扩张性心肌病左心室扩张和心肌重构中介导重要作用,其中TGF-β对心力衰竭具有较高预测价值。
Objective To explore the changes and significance of serum transformation growth factor β and growth differentiation factor 15 in patients with dilated cardiomyopathy. Methods A total of 168 patients with dilated cardiomyopathy were selected and divided into 4 groups according to the NYHA cardiac functional grading: 21 cases in grade Ⅰ, 45 cases in grade Ⅱ, 52 cases in grade Ⅲ and 50 cases in grade Ⅳ. The venous blood on the empty elbow of all the patients were extracted to detect serum TGF-β and GDF-15. Further more, their relationship with ventricular structure, cardiac function and prognosis were analyzed too. Results Ventricular structure, cardiac function and serum TGF-β and GDF-15 levels were significantly different among the groups. Compared with grade I, LVEDV and LVESV of grades II, III and IV increased, LVEF and CO decreased, and levels of TGF-β and GDF-15 increased; compared with grade II, LVEDV and LVESV of grade III and IV increased, LVEF and CO decreased, TGF-β and GDF-15 levels increased; compared with grade III, LVEDV and LVESV of grade IV increased, LVEF and CO decreased, and TGF-β and GDF-15 levels rose high, with the differences statistically significant(P<0.05). The incidence and mortality of heart failure in patients with grade IV were higher than those in grade I and II patients, and the differences were statistically significant(P<0.05). Serum TGF-β and GDF-15 levels were positively correlated with LVEDV and LVESV, negatively correlated with LVEF and CO, and had higher predictive value for heart failure(P<0.05). Conclusion TGF-β and GDF-15 play important roles in left ventricular dilatation and myocardial remodeling in dilated cardiomyopathy, and TGF-β has high predictive value for heart failure.
Objective To explore the changes and significance of serum transformation growth factor β and growth differentiation factor 15 in patients with dilated cardiomyopathy. Methods A total of 168 patients with dilated cardiomyopathy were selected and divided into 4 groups according to the NYHA cardiac functional grading: 21 cases in grade Ⅰ, 45 cases in grade Ⅱ, 52 cases in grade Ⅲ and 50 cases in grade Ⅳ. The venous blood on the empty elbow of all the patients were extracted to detect serum TGF-β and GDF-15. Further more, their relationship with ventricular structure, cardiac function and prognosis were analyzed too. Results Ventricular structure, cardiac function and serum TGF-β and GDF-15 levels were significantly different among the groups. Compared with grade I, LVEDV and LVESV of grades II, III and IV increased, LVEF and CO decreased, and levels of TGF-β and GDF-15 increased; compared with grade II, LVEDV and LVESV of grade III and IV increased, LVEF and CO decreased, TGF-β and GDF-15 levels increased; compared with grade III, LVEDV and LVESV of grade IV increased, LVEF and CO decreased, and TGF-β and GDF-15 levels rose high, with the differences statistically significant(P<0.05). The incidence and mortality of heart failure in patients with grade IV were higher than those in grade I and II patients, and the differences were statistically significant(P<0.05). Serum TGF-β and GDF-15 levels were positively correlated with LVEDV and LVESV, negatively correlated with LVEF and CO, and had higher predictive value for heart failure(P<0.05). Conclusion TGF-β and GDF-15 play important roles in left ventricular dilatation and myocardial remodeling in dilated cardiomyopathy, and TGF-β has high predictive value for heart failure.
引文
[1] 中华医学会心血管病学分会,中国心肌炎心肌病协作组. 中国扩张型心肌病诊断和治疗指南[J]. 临床心血管病杂志, 2018, 34(5): 421-434.
[2] 韦丙奇, 王运红, 黄燕, 等. 肥厚型心肌病心力衰竭呈扩张性心肌病改变与限制性心肌病改变患者的心脏结构和功能特点对比分析[J]. 中国循环杂志, 2018, 33(6): 580-584.
[3] Suzuki J, Aoyama N, Izumi Y, et al. Effect of periodontitis on cardiovascular manifestations in Marfan syndrome. Critical common role of TGF-β[J]. Int Heart J, 2015, 56(2): 121-124.
[4] Gohar A, Gon?alves I, Vrijenhoek J, et al. Circulating GDF-15 levels predict future secondary manifestations of cardiovascular disease explicitly in women but not men with atherosclerosis[J]. Int J Cardiol, 2017, 241(1): 430-436.
[5] 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会, 中国心肌病诊断与治疗建议工作组. 心肌病诊断与治疗建议[J]. 中华心血管病杂志, 2007, 35(1): 5-16
[6] 李艳芳. 射血分数保留的心力衰竭管理[J].中华老年心脑血管病杂志, 2017, 19(6): 563-565.
[7] 高渊, 牟建军. 高血压合并左心室肥厚的危害及逆转的临床意义[J]. 中华高血压杂志, 2016, 24(10): 906-909.
[8] Cor?ci OM, T?nasie CA, Alexandru DO, et al. A morpho-functional study using PEP/LVET ratio and global longitudinal strain in patients with dilated cardiomyopathy[J]. Rom J Morphol Embryol, 2018, 59(1): 93-103.
[9] Raja DC, Kapoor A, Sinha A, et al. Heart rate manipulation in dilated cardiomyopathy: Assessing the role of Ivabradine[J]. Indian Heart J, 2018, 70(2): 246-251.
[10] Sobrino-Márquez JM, Grande-Trillo A, Cantero-Pérez EM, et al. Prognostic Value of Blood Panel Parameters in Patients With Dilated Cardiomyopathy and Advanced Heart Failure[J]. Transplant Proc, 2018, 50(2): 650-652.
[11] Bonaterra GA, Zügel S, Thogersen J, et al. Growth differentiation factor-15 deficiency inhibits atherosclerosis progression by regulating interleukin-6-dependent inflammatory response to vascular injury[J]. J Am Heart Assoc, 2012, 1(6): e002550.
[12] Wang T, Liu J, McDonald C, et al. GDF15 is a heart-derived hormone that regulates body growth[J]. EMBO Mol Med, 2017, 9(8): 1150-1164.
[13] 刘素香. 妇可靖胶囊对盆腔炎患者血清中转化生长因子-β和血管细胞黏附分子-1和氧自由基水平的影响[J]. 中国卫生检验杂志, 2017, 27(22): 3257-3259.
[14] 江雪娟, 汤卫红, 管敏昌, 等. 习惯性流产患者血清血管内皮生长因子、转化生长因子-β1水平变化及临床意义[J]. 中国卫生检验杂志, 2017, 27(22): 3255-3256, 3259.
[15] 梁玉莲, 李传松, 蒋跃绒. 冠心病患者血清转化生长因子β_1与肝细胞生长因子水平变化及其临床意义[J]. 中国临床保健杂志, 2017, 20(2): 149-152.
[16] 乔靖, 杨建芳, 王溱. 瑞舒伐他汀钙治疗对冠心病合并阵发性房颤患者心功能及sE-selectin、TGF-β1的影响[J]. 内科, 2017, 12(4): 474-476, 479.
[2] 韦丙奇, 王运红, 黄燕, 等. 肥厚型心肌病心力衰竭呈扩张性心肌病改变与限制性心肌病改变患者的心脏结构和功能特点对比分析[J]. 中国循环杂志, 2018, 33(6): 580-584.
[3] Suzuki J, Aoyama N, Izumi Y, et al. Effect of periodontitis on cardiovascular manifestations in Marfan syndrome. Critical common role of TGF-β[J]. Int Heart J, 2015, 56(2): 121-124.
[4] Gohar A, Gon?alves I, Vrijenhoek J, et al. Circulating GDF-15 levels predict future secondary manifestations of cardiovascular disease explicitly in women but not men with atherosclerosis[J]. Int J Cardiol, 2017, 241(1): 430-436.
[5] 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会, 中国心肌病诊断与治疗建议工作组. 心肌病诊断与治疗建议[J]. 中华心血管病杂志, 2007, 35(1): 5-16
[6] 李艳芳. 射血分数保留的心力衰竭管理[J].中华老年心脑血管病杂志, 2017, 19(6): 563-565.
[7] 高渊, 牟建军. 高血压合并左心室肥厚的危害及逆转的临床意义[J]. 中华高血压杂志, 2016, 24(10): 906-909.
[8] Cor?ci OM, T?nasie CA, Alexandru DO, et al. A morpho-functional study using PEP/LVET ratio and global longitudinal strain in patients with dilated cardiomyopathy[J]. Rom J Morphol Embryol, 2018, 59(1): 93-103.
[9] Raja DC, Kapoor A, Sinha A, et al. Heart rate manipulation in dilated cardiomyopathy: Assessing the role of Ivabradine[J]. Indian Heart J, 2018, 70(2): 246-251.
[10] Sobrino-Márquez JM, Grande-Trillo A, Cantero-Pérez EM, et al. Prognostic Value of Blood Panel Parameters in Patients With Dilated Cardiomyopathy and Advanced Heart Failure[J]. Transplant Proc, 2018, 50(2): 650-652.
[11] Bonaterra GA, Zügel S, Thogersen J, et al. Growth differentiation factor-15 deficiency inhibits atherosclerosis progression by regulating interleukin-6-dependent inflammatory response to vascular injury[J]. J Am Heart Assoc, 2012, 1(6): e002550.
[12] Wang T, Liu J, McDonald C, et al. GDF15 is a heart-derived hormone that regulates body growth[J]. EMBO Mol Med, 2017, 9(8): 1150-1164.
[13] 刘素香. 妇可靖胶囊对盆腔炎患者血清中转化生长因子-β和血管细胞黏附分子-1和氧自由基水平的影响[J]. 中国卫生检验杂志, 2017, 27(22): 3257-3259.
[14] 江雪娟, 汤卫红, 管敏昌, 等. 习惯性流产患者血清血管内皮生长因子、转化生长因子-β1水平变化及临床意义[J]. 中国卫生检验杂志, 2017, 27(22): 3255-3256, 3259.
[15] 梁玉莲, 李传松, 蒋跃绒. 冠心病患者血清转化生长因子β_1与肝细胞生长因子水平变化及其临床意义[J]. 中国临床保健杂志, 2017, 20(2): 149-152.
[16] 乔靖, 杨建芳, 王溱. 瑞舒伐他汀钙治疗对冠心病合并阵发性房颤患者心功能及sE-selectin、TGF-β1的影响[J]. 内科, 2017, 12(4): 474-476, 479.