血浆三种标志物变化在晚期心力衰竭患者心血管事件预测中的初步分析  

Preliminary Research of Cardiovascular Events Risk Assessment in Patients With Advanced Heart Failure by Dynamic Changes of Three Biomarkers

作　　者：张荣成[1] 张宇辉[1] 张健[1] 黄燕[1] 郭潇[1] 王运红[1] 安涛[1] 周琼[1] 赵雪梅[1] 刘妮妮[1] 吕荣[1] 季诗明[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外心血管病医院心力衰竭中心,北京市100037

出　　处：《中国循环杂志》2015年第5期428-432,共5页Chinese Circulation Journal

基　　金："十二五"国家科技支撑计划重大项目心力衰竭项目(2011BA111B02)

摘　　要：目的 :观察晚期心力衰竭(心衰)患者治疗过程中血浆三种标志物早期的动态变化,并探讨这种变化在心血管事件预测中的价值。方法 :入选2013-10至2014-01阜外心血管病医院心衰中心住院的晚期心衰患者64例。分别测定患者入院时、3天及6天血浆N末端B型利钠肽原(NT-pro BNP)、B型利钠肽(BNP)及可溶性生长刺激表达基因2蛋白(s ST2)的水平,终点事件为心衰再住院、心脏移植或心血管死亡。随访观察6个月后根据是否发生心血管事件与否分为发生心血管事件组(24例)和未发生心血管事件组(40例)。结果 :发生心血管事件组患者住院6天各标志物水平无明显变化,未发生心血管事件组患者NT-pro BNP及BNP较入院时均明显降低,差异有统计学意义(P<0.05),但s ST2变化无统计学意义。通过ROC曲线分析,与入院时水平相比,治疗后6天各标志物水平可以更好地预测心血管事件,s ST2在各研究阶段预测心血管事件的能力均高于NT-pro BNP与BNP。结论 :晚期心衰患者治疗后标志物的水平较入院时具有更强的心血管事件预测能力,s ST2可以更有效评估晚期心衰患者的心血管事件风险。Objective：To observe the dynamic changes of 3 plasma biomarkers in treating the patients with advanced heart failure（HF） and to explore the predictive value of those changes for the occurrence of cardiovascular（CV） events.Methods：A total of 64 consecutive patients with advanced HF treated in our hospital from 2013-10 to 2014-01 were enrolled.The plasma levels of N-terminal pro-B–type natriuretic peptide（NT-pro BNP）,BNP and soluble ST2（s ST2） were examined at admission,3 days and 6 days after admission respectively.The patients were followed-up for 6 months,the end points included re-admission for worsening HF,cardiac transplantation or cardiovascular death.The patients were divided into 2 groups as With CV event group,n=24 and Without CV event group,n =40.Results：With 6 days of treatment,the above plasma biomarkers had no significant changes in With CV event group,while in Without CV event group,plasma levels of NT-pro BNP,BNP were obviously decreased,P 〈0.05,but s ST2 level remained similar.Receiver operating characteristic（ROC） curve analysis indicated that compared the baseline of admission,after 6 days of treatment,the above biomarkers may better predict the occurrence of CV events,the predictive value of s ST2 was even higher than NT-pro BNP and BNP at different stage during the follow-up period,all P 〈0.05.Conclusion：Plasma levels of NT-pro BNP and s ST2 had the stronger predictive value for CV event occurrence inadvanced HF patients after proper treatment.The s ST2 level may assess the risk of CV events in advanced HF patients more effectively.

关 键 词：标志物 心力衰竭 心血管事件 

分 类 号：R541[医药卫生—心血管疾病]