血清可溶性基质裂解素2水平与心力衰竭严重程度及预后的关系  

The relationship between the serum level of soluble ST2 and the severity and prognosis of heart failure

作　　者：苏嵘 赵娜[2] 齐新[2] 吴晓东[2] 齐延芳[2] 侯文广[2] 刘克强[2] 

机构地区：[1]天津中医药大学,300193 [2]天津市人民医院心内科

出　　处：《天津医药》2018年第1期46-50,共5页Tianjin Medical Journal

基　　金：天津市卫生计生委科技基金(2015KG110);天津市科技计划项目(16XMJSY00060)

摘　　要：目的探讨血清可溶性基质裂解素2(s ST2)水平在心力衰竭患者不同分期的变化及与预后的关系。方法纳入处于心力衰竭A、B、C、D各期患者共300例为病例组,入选同期体检中心进行体检的老年健康人群33例为对照组。收集所有观察对象的一般资料,完善心脏彩色超声检查及s ST2、氨基末端脑钠肽前体(NT-pro BNP)等相关生化指标检测,根据西雅图心力衰竭模型(SHFM)评估心力衰竭患者生存年限,并进行1年随访,记录临床不良事件发生情况。结果病例组患者s ST2水平高于对照组,于B期开始升高,且随着心功能分期的发展而增加,B、C、D期高于A期,D期高于B、C期,差异有统计学意义(P<0.05);高s ST2水平组患者的临床不良事件发生率、左室舒张末期内径(LVEDD)、左心室质量指数(LVMI)均高于低s ST2水平组,差异有统计学意义(P<0.05);不良事件组s ST2、NT-pro BNP、LVEDD、LVMI水平高于无不良事件组,左室射血分数(LVEF)、SHFM预期寿命低于无不良事件组,差异有统计学意义(P<0.05);s ST2与LVEF呈负相关,与NT-pro BNP、LVEDD、LVMI呈正相关,差异有统计学意义(P<0.05);s ST2用于判定心血管终点事件发生情况的ROC曲线下面积为0.665(95%CI:0.574~0.757,P<0.01),NT-pro BNP的ROC曲线下面积为0.790(95%CI:0.731~0.848,P<0.01),s ST2预测临床不良事件的最佳cut-off值为139.27μg/L,NT-pro BNP的最佳cut-off值855.35μg/L。结论血清s ST2是心力衰竭进展早期指标,其不仅反映心室重构的严重程度,也是评估心力衰竭患者1年内预后的指标之一。Objective To investigate serum levels of soluble matrix lysin 2(s ST2) in patients with different stages ofheart failure and its relationship with prognosis.MethodsData of 300 patients with heart failure of stages A, B, C and Dwere included in this study. Thirty-three cases of healthy elderly population for physical examination were used as controlgroup. The general information, echocardiography and related biochemical tests containing s ST2 and NT-pro BNP werecollected in the two groups. The survival periods of patients were evaluated according to the Seattle heart failure mode(SHFM). Patients were followed up for 1 year to record the occurrence of adverse events.ResultsThe s ST2 level was higherin heart failure group than that of control group. The s ST2 level began to increase in stage B, and which increased with thedevelopment of cardiac function staging. The s ST2 levels were significantly higher in stages B, C and D than those of stage A,and which were significantly higher in stage D than those of stages B and C(P<0.05). There were significantly higherincidence rates of adverse events, left ventricular end diastolic diameter(LVEDD) and left ventricular mass index(LVMI) inthe patients with high s ST2 level than those of patients with lower s ST2 level(P<0.05). Values of s ST2, NT-pro BNP,LVEDD and LVMI were significantly higher, and values of LVEF and SHFM life expectancy were significantly lower, inpatients with adverse events than those of patients without adverse events(P<0.05). There was a negative correlationbetween sST2 and LVEF, and positive correlation between sST2 with NT-proBNP, LVEDD and LVMI(P<0.05). The sizeunder ROC curve, which was used to predict the cardiovascular endpoint events judged by s ST2 was 0.665(95% CI: 0.574-0.757, P<0.01), and the one by NT-pro BNP was 0.790(95% CI: 0.731-0.848, P<0.01). The best cut-off value ofpredicting the clinical adverse events was 139.27 μg/L by s ST2 and 855.35 μg/L by NT-pro BNP.ConclusionThe serumlevel of s ST2 is early indicator of heart failure, whi

关 键 词：心力衰竭 心室重构 利钠肽 脑 预后 N末端B型利钠肽原 可溶性ST2 

分 类 号：R541.6[医药卫生—心血管疾病]