急性心力衰竭患者血清可溶性ST2受体及N末端B型脑钠肽前体水平变化及意义  

Change and significance of soluble ST2 and NT-proBNP levels in patients with acute heart failure

作　　者：闫雪 王惠琴[1] YAN Xue;WANG Huiqin(Department of Cardiology,the First Central Hospital of Baoding,Baoding 071000,China)

机构地区：[1]保定市第一中心医院心内科

出　　处：《中华实用诊断与治疗杂志》2020年第1期29-32,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河北省医学科学研究重点课题计划项目(20181484)

摘　　要：目的探讨急性心力衰竭(acute heart failure, AHF)患者血清可溶性ST2受体(soluble ST2, sST2)、N末端B型脑钠肽前体(N-terminal B-type brain natriuretic peptide precursor, NT-proBNP)水平变化及其在病情评估中的价值。方法 AHF患者128例(AFP组),其中NYHA心功能Ⅱ级48例、Ⅲ级41例、Ⅳ级39例,同期45例体检健康者为对照组。检测各组血清sST2、NT-proBNP水平;对AHF患者给予规范性治疗并随访6个月,47例发生不良事件者为不良事件组,81例未发生不良事件者为无不良事件组,比较2组一般资料、血脂及血清ST2、NT-proBNP水平,多因素logistic回归分析AHF患者发生不良事件的影响因素,绘制ROC曲线评估血清sST2、NT-proBNP预测AHF患者近期发生不良事件的效能。结果 AHF组血清sST2[(83.4±10.6)μg/L]、NT-proBNP[(4 416.5±433.2)ng/L]水平高于对照组[(42.9±7.6)μg/L、(164.1±36.3)ng/L](P<0.05);NYHA心功能Ⅱ、Ⅲ、Ⅳ级患者血清sST2[(74.7±9.8)、(95.3±14.2)、(131.5±18.7)μg/L]、NT-proBNP[(3 127.9±379.9)、(4 607.7±422.1)、(5 835.4±497.8)ng/L]水平依次增高(P<0.05);不良事件组血清sST2[(126.7±13.3)μg/L]、NT-proBNP[(5 265.8±470.6)ng/L]水平高于无不良事件组[(75.6±10.4)μg/L、(3 461.6±379.4)ng/L](P<0.05),NYHA心功能Ⅳ级比率(46.81%)高于无不良事件组(20.99%)(P<0.05);多因素logistic回归分析结果显示,血清sST2(OR=3.207,95%CI:1.908~4.271,P=0.011)、NT-proBNP(OR=3.416,95%CI:2.302~4.818,P=0.006)是AHF患者发生不良事件的影响因素;ROC曲线分析结果显示,sST2以93.6μg/L为最佳截断值,预测不良事件的AUC为0.809(95%CI:0.728~0.912,P<0.05),灵敏度为81.1%,特异度为74.3%;NT-proBNP以4 152.7 ng/L为最佳截断值,预测不良事件的AUC为0.839(95%CI:0.766~0.981,P<0.05),灵敏度为60.5%,特异度为94.1%;sST2联合NT-proBNP预测不良事件的AUC为0.846(95%CI:0.773~0.912,P=0.027),灵敏度为86.7%,特异度为94.3%。结论 AHF患者血清ST2、NT-proBNP水平随心功能分级升高而增高;血清ST2Objective To investigate the changes of serum soluble ST2 receptor(sST2) and N-terminal B-type brain natriuretic peptide precursor(NT-proBNP) in patients with acute heart failure(AHF) and its value in the evaluation of disease. Methods The serum levels of sST2 and NT-proBNP were detected in 128 AHF patients(AHF group) including 48 patients in NYHA grade Ⅱ, 41 patients in grade Ⅲ and 39 patients in grade Ⅳ, and 45 healthy volunteers(control group). AHF group received standard therapy and was divided into 47 patients with adverse events(adverse events group) and 81 patients without adverse events(non-adverse events group) after 6-month follow-up. The general data, blood lipid and serum levels of sST2 and NT-proBNP were compared between two groups. Multivariate logistic analysis was used to analyze the risk factors for adverse events in AHF patients. ROC was drawn to evaluate the efficacies of serum sST2 and NT-proBNP on predicting the adverse events in AHF patients. Results The levels of sST2 and NT-proBNP were higher in AHF group((83.4±10.6) μg/L,(4 416.5±433.2) ng/L) than those in control group((42.9±7.6) μg/L,(164.1±36.3) ng/L)(P<0.05). The levels of sST2((74.7±9.8,(95.3±14.2),(131.5±18.7) μg/L) and NT-proBNP((3 127.9±379.9),(4 607.7±422.1),(5 835.4±497.8) ng/L) increased gradually in turn in patients in NYHA grade Ⅱ, Ⅲ and Ⅳ(P<0.05). The levels of sST2 and NT-proBNP were higher in adverse events group((126.7±13.3) μg/L,(5 265.8±470.6) ng/L) than those in non-adverse events group((75.6±10.4) μg/L,(3 461.6±379.4) ng/L,(P<0.05), and the percentage of NYHA grade Ⅳ was higher in adverse events group(46.81%) than that in non-adverse events group(20.99%)(P<0.05). Logistic regression analysis showed that the serum sST2(OR=3.207, 95%CI: 1.908-4.271, P=0.011) and NT-proBNP(OR=3.416, 95%CI: 2.302-4.818,P=0.006)were the influencing factors for adverse events in AHF patients.ROC showed when the optimal cut-off of serum sST2 was 93.6μg/L,the AUCfor adverse events was 0.809(95%CI:0.728-0.912,

关 键 词：急性心力衰竭 可溶性ST2受体 N末端B型脑钠肽前体 

分 类 号：R541.6[医药卫生—心血管疾病]