抑郁障碍对慢性收缩性心力衰竭患者sST2、NT-pro BNP和Ghrelin水平及预后的影响  

Effect of Depressive Symptoms on Plasma Levels of Soluble ST2,NT-pro BNP and Ghrelin,and the Prognosis of Patients with Systolic Heart Failure

作　　者：徐素丹[1] 卢永昕[1] 苏冠华[1] 帅欣欣[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院心血管内科,武汉430022

出　　处：《华中科技大学学报（医学版）》2014年第3期285-291,共7页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

摘　　要：目的探讨抑郁障碍对慢性收缩性心力衰竭患者血浆中分泌型ST2（sST2）和神经激素（NT—proBNP与Gh—relin）水平及其预后的影响。方法纳入射血分数≤40％，平均年龄（60±12）岁的146例心衰患者，分别接受医院焦虑抑郁量表（HADS）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）和明尼苏达心力衰竭生活质量量表（ML-HFQ）的评估，并测定血浆sST2、NT-proBNP和Ghrelin水平。所有患者随访9个月，初级终点是全因死亡和因心衰再次住院。结果与心衰无抑郁障碍组患者相比，心衰合并抑郁障碍的患者（52例，35．6％）血浆sST2水平（55．3ng／mL％41．1ng／mL，P％0．01）和NT—proBNP水平（5886pg／mL＂US．2682pg／mL，P％0．01）显著增高，而Ghrelin水平降低（7．0ng／mL7dS．7．9ng／mL，P=0．041）。sST2和NT—proBNP水平与抑郁障碍独立相关。9个月随访期间抑郁障碍组全因死亡率（32．7％VS．7．4％，P％0．01）和因心衰再住院率（48．1％ vs 27．7％，P〈0．01）显著高于无抑郁障碍组。多因素Cox回归分析显示在校正临床相关变量后抑郁障碍（HR2．24，95％ CI 1．18～4．25，P=0．014）仍是心衰患者全因死亡和心衰再住院的独立危险因素。伴抑郁障碍且sST2〉45．1ng／mL或NT—proBNP〉3286pg／mL的心衰患者全因死亡和心衰再住院的风险显著增加。结论心衰伴抑郁障碍的患者血浆sST2和NT—proBNP水平增高，Ghrelin水平降低。抑郁障碍联合sST2或NT-proBNP对心衰患者不良预后有较高的预测价值。Objective To examine the influence of depressive symptoms on plasma levels of soluble ST2 （sST2） and neurohormones I-N-terminal pro-brain natriuretic peptide （NT-pro BNP） and ghrelin2 in patients with systolic heart failure （HF） and on the prognosis of these patients. Methods A cohort of 146 HF patients with ejection fraction≤40% and an average of （60 12） years were followed up for 9 months. The psychological status was evaluated by Hospital Anxiety and Depression Scale, Hamilton Depression Scale and Hamilton Anxiety Scale. The quality of life was assessed by Minnesota Living with Heart Failure Questionnaire （MLHFQ）. Plasma levels of sST2, NT-pro BNP and ghrelin were measured at baseline. The primary endpoint was all-cause mortality and HF-related hospitalization. Results HF patients with depressive symptoms （n = 52,35.6 %） had higher levels of sST2 （55.3 ng/mL vs. 41. 1 ng/mL,P〈0.01） and NT-pro BNP （5 886 pg/mL vs. 2 682 pg/mI,,P-~0.01）, but lower levels of ghrelin （7.0 ng/mL vs. 7.9 ng/mL, P=0. 041）, compared with those without depressive symptoms. The levels of sST2 and NT-pro BNP were independently associated with depressive symptoms. After 9-month follow-up, the all- cause mortality and HF-related hospitalization rate were significantly increased in HF patients with depressive symptoms when compared with those without depressive symptoms （32.7~~ vs. 7.4% for all-cause mortality,48.1% vs. 27.7% for HF-related hospitalization rate;P%0.01 for bmh）. Multivariate Cox regression analysis showed that the depressive symptoms were inde- pendent risk factors of all cause mortality and HF related hospitalization in HF patients after adjusting for clinical covariates Ehazard ratio （HR） 2.24,95% confidence interval （CI） 1.18--4.25,P=0. 0141. The all-cause mortality and HF-related hospitalization were significantly increased in HF patients with depression symptoms and sST2-45.1 ng/mL or NT pro BNP〉 3 286 pg/mL. Conclusion The levels of sST2 and NT-pro BNP were signific

关 键 词：分泌型ST2 NT-pro BNP GHRELIN 心力衰竭 抑郁障碍 

分 类 号：R543.3[医药卫生—心血管疾病]