用可溶性白介素33受体配体评估艾森曼格综合征患者预后的临床研究  

The predictive value of soluble ST2 for short-term prognosis in eisenmenger syndrome patients

作　　者：郑璇[1,2] 李珊珊[1] 颜梦欢 邓晓娴[1] 金博文 胡元萍[2,3] 曹树正[3] 余洁 周红梅[1] 张刚成[1] ZHENG Xuan;LI Shan-shan;YAN Meng-huan;DENG Xiao-xian;JIN Bo-wen;HU Yuan-ping;CAO Shu-zheng;YU Jie;ZHOU Hong-mei;ZHANG Gang-cheng(Center for Congenital Heart Diseases,Wuhan Asia Heart Hospital,Wuhan 430022,China)

机构地区：[1]武汉亚洲心脏病医院先心病中心,湖北武汉430022 [2]武汉亚洲心脏病医院分子心脏病学实验室,湖北武汉430022 [3]武汉亚洲心脏病医院检验中心,湖北武汉430022

出　　处：《中国介入心脏病学杂志》2020年第8期436-439,共4页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金青年项目(81702059);湖北省自然科学基金青年项目(2017cFB256);湖北省卫生健康委员会基金项目(WJ2019M033);湖北省卫生健康委员会联合基金(WJ2019H242)。

摘　　要：目的探讨将可溶性白介素33受体配体(sST2)用于评估艾森曼格综合征(ES)患者短期预后的临床价值。方法回顾性观察2016年6月至2018年6月在武汉亚洲心脏病医院诊断的ES患者39例,记录其在随访期间临床结局的发生情况。临床结局定义为随访期间患者出现临床结局恶化相关事件,包括全因死亡、再入院及临床恶化(咯血、心功能恶化等)。随访期间,共4例患者发生临床结局恶化事件为临床恶化组,35例为预后良好组。利用酶联免疫吸附试验检测患者入院时血清中sST2,观察其对ES患者短期预后的评估价值。结果临床恶化组4例患者发生临床结局恶化事件,其中3例咯血,1例死亡。临床恶化组患者年龄[(22.00±8.12)岁比(38.51±11.15)岁,P=0.007]、入院时血清sST2[62.10(22.50,140.40)ng/ml比23.19(8.42,53.00)ng/ml,P<0.001]、尿酸(UA)[(525.75±180.29)μmol/L比(383.89±115.48)μmol/L,P=0.034]与预后良好组患者比较,差异均有统计学意义。受试者工作特征曲线显示,sST2=50 ng/ml时,预测临床结局恶化事件的敏感度为75.0%,特异度为95.3%,曲线下面积为0.864(P=0.018)。当以年龄中位数、UA中位数和sST2≥50 ng/ml为截断值,经Cox回归分析发现,sST2≥50 ng/ml是ES患者发生临床结局恶化事件的独立危险因素(HR 1.041,95%CI 1.012~1.071,P=0.006)。当sST2≥50 ng/ml时,患者临床结局恶化事件发生率显著高于sST2<50 ng/ml的患者(60.0%比2.9%,P<0.001)。结论入院时sST2与ES患者短期临床预后显著相关。血清sST2=50 ng/ml可用于鉴别短期预后不良的ES患者,提示需加强关注,强化治疗。Objective To assess the predictive value of soluble ST2(sST2)in patients with eisenmenger symdrome(ES)during short-term follow-up.Methods Thirty-nine patients diagnosed as ES in our center from June 2016 to June 2018 were included in this study.Clinical outcome data during follow up,which was defi ned as major events associated with adverse clinical endpoint,including all-cause mortality,re-admission and worsening of clinical situation such as hemoptysis,decreased heart function,etc.were recorded.The serum sST2 was measured by enzyme linked immune sorbent assay(ELISA)at admission.Results During 12-month follow-up,there were 4 patients having adverse events,including 3 of hemoptysis and 1 death.Patients with more adverse events were younger[(22.00±8.12)years old vs.(38.51±11.15)years old,P=0.007],had significantly higher sST2[62.10(22.50,140.40)ng/ml vs.23.19(8.42,53.00)ng/ml,P<0.001]and serum UA[(525.75±180.29)μmol/L vs.(383.89±115.48)μmol/L,P=0.034]at admission than those who were events free.With ROC regression analysis,sST2=50 ng/ml,the predictive model for adverse events had a sensitivity of 75.0%and specifi city of 95.3%,with AUC of 0.864(P=0.018).Patients with sST2 more than 50 ng/ml had worse prognosis(60.0%vs.2.9%,P<0.001,HR 1.041,95%CI 1.012–1.071,P=0.006).Conclusions Level of sST2 at admission was signifi cantly associated with short-term prognosis of ES patients.sST2=50 ng/ml might be helpful to identify the CHD-PAH patients with worse prognosis in short-term.

关 键 词：先天性心脏病 肺动脉高压 艾森曼格综合征 可溶性ST2 预后评估 

分 类 号：R541.1[医药卫生—心血管疾病] R543.2[医药卫生—内科学]