可溶性ST2与半乳凝集素3在扩张型心肌病患者中的水平及临床意义  被引量:22

The levels and significance of soluble ST2 and galectin-3 in patients with dilated cardiomyopathy

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作  者:靳杨 范雪松[1] 贺建勋[1] 袁慧[1] Jin Yang;Fan Xuesong;He Jianxun;Yuan Hui(Clinical Laboratory of Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区:[1]首都医科大学附属北京安贞医院检验科,100029

出  处:《中华检验医学杂志》2019年第1期31-37,共7页Chinese Journal of Laboratory Medicine

基  金:国家自然科学基金(81770353).

摘  要:目的测定扩张型心肌病(DCM)心衰患者血清可溶性ST2(sST2)及半乳凝集素(gal-3)水平,探讨其在扩张型心肌病心衰中的应用价值及临床意义。方法采用横断面调查研究,收集首都医科大学附属北京安贞医院心血管内科2017年6月至12月住院的扩张型心肌病心力衰竭患者60例作为疾病组,收集冠状动脉粥样硬化性心脏病(CHD)性心力衰竭患者52例作为疾病对照,健康体检患者70名作为健康对照组。将DCM患者按纽约心脏病协会(New York Heart Association,NYHA)心功能分级,心功能Ⅰ~Ⅱ级组18例(男/女为11/7),心功能Ⅲ~Ⅳ级组42例(男/女为32/10)。sST2采用酶联免疫法进行测定,gal-3采用化学发光法进行测定。采用单因素方差分析,非参数检验以及Spearman直线相关分析等统计学方法进行分析。结果DCM组与健康对照组比较,血清sST2水平显著升高[21.23(14.59,25.29)ng/ml vs 14.59(12.78,17.16)ng/ml,标准化H=4.645,调整后P<0.001],血清gal-3水平也显著增高[13.50(10.48,19.68)μg/L vs 10.05(8.25,12.80)μg/L,标准化H=4.266,调整后P<0.001]。DCM组与CHD组相比,血清gal-3水平明显升高[13.50(10.48,19.68)μg/L vs 11.00(8.65,13.58)μg/L,标准化H=-2.715,调整后P=0.020]。sST2在心功能Ⅲ~Ⅳ级组较Ⅰ~Ⅱ级组显著升高[22.54(16.82,26.78)ng/ml vs 12.24(9.22,17.79)ng/ml,Z=2.613,P=0.009]。Spearman相关分析显示,sST2与左心室射血分数(LVFE)呈负相关(r=-0.647,P<0.01),与左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)呈正相关(r=0.393,r=0.462,均P<0.01),与B-型尿钠肽(BNP)、gal-3呈正相关(r=0.320,r=0.331,均P<0.05);gal-3与超敏肌钙蛋白I(hs-TnI)、BNP呈正相关(r=406,r=0.401,均P≤0.01),与估算的肾小球滤过率(eGFR)呈负相关(r=-0.326,P<0.05)。sST2诊断DCM心衰的ROC曲线下面积为0.745,(95% CI:0.652~0.838,P<0.001),其Cut-off值为21.00 ng/ml,在此Cut-off值下的敏感度为51.9%,特异度为95.7%;gal-3诊断DCM心衰的ROC曲线下面积为(0.720,95% CI:0.627~0.81Objective The study aimed to investigate the clinical value of serum soluble ST2(sST2) and galectin-3(gal-3) in dilated cardiomyopathy(DCM) patients associated with heart failure.Methods 60 DCM patients with heart failure were collected in Anzhen Hospital Department of Cardiology from June to December 2017 as researching group. 52 coronary heart disease(CHD) patients with heart failure were as the controls, also, 70 healthy controls were analyzed by cross-sectional investigation. In DCM group, 18 patients (male/female:11/7) were enrolled in the NYHA(New York Heart Association) cardiac function Ⅰ-Ⅱ group and 42 patients (male/female: 32/10) were enrolled in the NYHA cardiac function Ⅲ-Ⅳ group. sST2 was detected by enzyme-linked immunoassay;gal-3 was detected by chemiluminescence immunoassay. One-Way ANOVA, non-parametric test, Spearman linear correlation analysis and other statistical methods were used in our study.Results Compared with healthy controls, the serum level of sST2 in DCM group increased markedly [21.23(14.59,25.29) ng/ml vs 14.59(12.78,17.16) ng/ml, standardized H=-4.645,adjusted P<0.001], and significantly higher serum level of gal-3 [13.50(10.48,19.68)μg/L vs 10.05(8.25, 12.80) μg/L, standardized H=4.266, adjusted P<0.001]. Compared with CHD group, there was a significant increase [13.50(10.48, 19.68) μg/L vs 11.00(8.65, 13.58) μg/L, standardized H=-2.715, adjusted P=0.020] in the expression of serum gal-3 in DCM group. The serum level of sST2 in cardiac function Ⅲ-Ⅳ group was obviously higher than that in the Ⅰ-Ⅱ group [22.54(16.82,26.78)ng/ml vs 12.24(9.22,17.79) ng/ml, Z=2.613,P=0.009].Spearman correlation analysis showed a negative correlation between sST2 and left ventricular ejection fraction(LVFE)(r=-0.647, P<0.01), but a positive correlation between left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic dimension(LVESD)(r=0.393,r=0.462,all P<0.01). The correlation of sST2 and B-type natriuretic peptide(BNP)/gal-3 (r=0.320,r=0.331,all P<0.05),ga

关 键 词:心肌病 扩张型 白细胞介素1受体样蛋白1 半乳糖凝集素3 

分 类 号:R542.2[医药卫生—心血管疾病] R446.6[医药卫生—内科学]

 

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