血清sST2及TIMP-1、TIMP-2水平与慢性心力衰竭患者临床预后的相关性  

Correlation between serum sST2,TIMP-1,TIMP-2 levels and clinical prognosis of patients with chronic heart failure

作　　者：杨小凤[1] 胡蓉[1] 黄璜[1] 曹桢 曹胜兰[1] 许勇[1] YANG Xiao-Feng;HU Rong;HUANG Huang(Department of Cardiology,Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610000,Sichuan,China)

机构地区：[1]成都中医药大学附属医院心内科,四川成都610000

出　　处：《中国老年学杂志》2020年第19期4033-4037,共5页Chinese Journal of Gerontology

基　　金：国家自然科学基金青年基金项目(81603615)。

摘　　要：目的探讨血清可溶性基质裂解素(sST)2及金属蛋白酶组织抑制因子(TIMP)-1、TIMP-2水平与慢性心力衰竭(心衰)患者临床预后的相关性。方法选取2017年1月至2020年1月慢性心衰患者125例(心衰组)及心功能正常且无心脏病的中老年体检者60例(健康对照组)。检测两组入院时心衰标志物、超声心动图及sST2、TIMP-1和TIMP-2水平。心衰患者进行规范化治疗,出院时复查sST2、TIMP-1和TIMP-2水平,并进行1年随访,以受试者工作特征(ROC)曲线评估出院时血清sST2、TIMP-1、TIMP-2对出院1年内不良预后的预测价值。结果心衰组血清sST2水平明显高于对照组(P<0.05),TIMP-1、TIMP-2水平明显低于对照组(P<0.05)。血清sST2与心功能分级和N末端B型利钠肽(NT-proBNP)呈正相关(r=0.623,0.420;均P=0.000),与左室射血分数(LVEF)呈负相关(r=-0.439;P=0.000)。TIMP-1、TIMP-2与心功能分级呈负相关(r=-0.384,-0.521;均P=0.000),与NT-proBNP呈负相关(r=-0.341,-0.387;均P=0.000),与LVEF呈正相关(r=0.488,0.325;均P=0.000)。心衰预后良好患者出院时血清sST2水平明显低于预后不良患者(P<0.05),TIMP-1、TIMP-2水平明显高于预后不良患者(P<0.05)。心衰患者出院时sST2水平(临界值≥48.43μg/L)、TIMP-1水平(临界值≤252.36pg/ml)和TIMP-2水平(临界值≤329.49pg/ml)对预测出院1年内不良预后的灵敏度分别为81.80%、84.80%和81.80%,特异度分别为73.90%、76.10%和62.00%,曲线下面积(AUC)=0.842,0.872,0.792。结论血清sST2及TIMP-1、TIMP-2水平与心衰标志物及临床预后具有明显相关性,慢性心衰患者出院时sST2、TIMP-1和TIMP-2水平对预测1年内不良预后有较高价值。Objective To explore the correlation between levels of serum soluble human stromelysin(sST)2,tissue inhibitor of metalloproteinase(TIMP)-1 and TIMP-2 and clinical prognosis of patients with chronic heart failure(CHF).Methods During the period from January 2017 to January 2020,125 CHF patients(heart failure group)and 60 middle-aged and elderly patients with normal cardiac function and without heart disease(healthy control group)were enrolled.The heart failure markers,echocardiogram(ECG),levels of sST2,TIMP-1 and TIMP-2 at admission in both groups were detected.Patients with heart failure were given standardized treatment.At discharge,levels of sST2,TIMP-1 and TIMP-2 were re-examined.And then,they were given 1-year follow-up.Predictive value of serum sST2,TIMP-1 and TIMP-2 at discharge in poor prognosis within 1 year after discharge was evaluated by ROC curves.Results The level of serum sST2 in heart failure group was higher than that in control group(P<0.05),while levels of TIMP-1 and TIMP-2 were lower than those in control group(P<0.05).Serum sST2 was positively correlated with cardiac function grading and N-terminal pro brain natriuretic peptide(NT-proBNP)(r=0.623,r=0.420;P=0.000),while negatively correlated with left ventricular ejection fraction(LVEF,r=-0.439;P=0.000).TIMP-1 and TIMP-2 were negatively correlated with cardiac function grading(r=-0.384,r=-0.521;P=0.000),negatively correlated with NT-proBNP(r=-0.341,r=-0.387;P=0.000),while positively correlated with LVEF(r=0.488,r=0.325;P=0.000).At discharge,level of serum sST2 in patients with good prognosis was lower than that with poor prognosis(P<0.05),while levels of TIMP-1 and TIMP-2 were higher than those with poor prognosis(P<0.05).The sensitivity and specificity of sST2(critical value not lower than 48.43μg/L),TIMP-1(critical value not higher than 252.36 pg/ml)and TIMP-2(critical value not higher than 329.49 pg/ml)at discharge for predicting poor prognosis within 1 year after discharge were(81.80%,84.80%,81.80%)and〔73.90%,76.10%,62.00%(AUC=0.842,AUC=0

关 键 词：慢性心力衰竭 可溶性基质裂解素2 金属蛋白酶组织抑制因子-1 金属蛋白酶组织抑制因子-2 不良预后 

分 类 号：R541[医药卫生—心血管疾病]