可溶性ST2在射血分数保留的心力衰竭患者中的表达及其预后价值  

Plasma soluble ST2 level and prognostic value in patients with heart failure with preserved ejection fraction

作　　者：张丽[1] 丁世芳[1] 蒋桔泉[1] 陈志楠[1] 卢青[1] 付文波[1] 彭毅[1] 

机构地区：[1]南方医科大学附属广州军区武汉总医院心内科,武汉430000

出　　处：《临床心血管病杂志》2016年第5期487-491,共5页Journal of Clinical Cardiology

摘　　要：目的：比较射血分数保留的心力衰竭（HFPEF）患者和射血分数下降的心力衰竭（HFREF）患者治疗过程中血浆可溶性ST2（sST2）及氨基末端脑钠肽前体（NT-proBNP）的水平和早期变化,并探讨其对心血管事件的预测价值。方法：将61例急性失代偿性心衰患者按照左室射血分数（LVEF）分为HFPEF组（35例）及HFREF组（26例）。比较两组入院时、入院第7天sST2及NT-proBNP的水平,随访并记录患者入院后6个月心血管事件（全因死亡、心衰再住院）的发生情况。结果：HFREF组患者入院时、入院第7天sST2、NT-proBNP水平高于HFPEF组（均P〈0.05）。两组入院第7天NT-proBNP水平较入院时明显下降,而sST2在治疗过程中变化不明显。经Logsitic回归分析发现（纳入因素包括NT-proBNP）,入院时sST2水平是上述两种心衰患者发生心血管事件的独立危险因素（HFPEF组：OR：1.411,95%CI：1.038~1.918,P〈0.05;HFREF组：OR：1.033,95%CI：1.009~1.058,P〈0.001）。通过ROC曲线发现,只有NT-proBNP的变化值具有预测心血管事件的价值（ROC曲线下面积为0.753,界值为2 852pg/ml,灵敏度92.3%,特异度56.2%,P=0.005）。而治疗过程中sST2水平的短期变化值无预测心血管事件的价值。结论：HFPEF患者血浆sST2水平显著低于HFREF患者。入院时sST2水平是急性心衰患者发生心血管事件的独立危险因素,与LVEF无关。NT-proBNP水平的短期变化具有预测心血管事件的价值。Objective：To observe the early changes of sST2 level and N-terminal pro-B type natriuretic peptide（NT-proBNP）in heart failure patients with preserved ejection fraction（HFPEF）or reduced ejection fraction（HFREF）and explore the predictive value of these 2biomarkers for the occurrence of cardiovascular events.Method：A total of 61 patients with acute decompensated heart failure were enrolled and were divided into two groups according to left ventricular ejection fraction（LVEF）：HFPEF group（n=35）and HFREF group（n=26）.Plasma sST2 and NT-proBNP levels were compared at admission and 7days after admission respectively.The patients were followed up for 6months and the occurrence of cardiovascular events（including all cause motality,re-admission for worsening HF）were recorded.Result：The sST2 levels were significantly greater in patients with HFREF than in those with HFPEF at admission and 7days after admission.The NT-proBNP levels decreased obviously after treatment（P〈0.05）in both groups,but sST2 levels remained similar.In the adjusted regression analyses that included NT-proBNP,sST2 levels at admission were associated with agreater cardiovascular events risk in both groups（HFPEF group OR：1.411,95%CI：1.038-1.918,P〈0.05;HFREF group OR：1.033,95%CI：1.009-1.058,P〈0.001）.Receiver operating characteristic curve（ROC）analysis indicated that the change of NT-proBNP levels had predictive value for cardiovascular events（area under curve 0.753,cut-off point 2 852pg/ml,sensitivity 92.3%,specificity 56.2%,P=0.005）.While the occurrences of cardiovascular events were not predicted by change of sST2 levels.Conclusion：The sST2 levels are lower in patients with HFPEF.The baseline levels of sST2 remain an independent predictor of the occurrence of cardiovascular events,regardless of the left ventricular ejection fraction.The change of NT-proBNP levels also has predictive value for the occurrence of cardiovascular events.

关 键 词：心力衰竭 可溶性ST2 氨基末端脑钠肽前体 左室射血分数 心血管事件 

分 类 号：R541.6[医药卫生—心血管疾病]