H2S和sST2与射血分数降低的心力衰竭的相关性研究  

Correlation between HS,soluble ST2 and heart failure with reduced ejection fraction

作　　者：何智余[1] 武锋超 马兰虎 张涛 朱文彤 张益铭[1] 蓝庆肃 姚亚丽[1] HE Zhiyu;WU Fengchuo;MA Lanhu;ZHANG Tao;ZHU Wentong;ZHANG Yiming;LAN Qingsue;YAO Yalil(Department of Cardiology.the First Hospital of Lanzhou University.Lanzhou.730000,China;The First Clinical Medical College,Lanzhou University;Department of Cardiology.Jinchang Integrated Chinese and Western Medicine Hospital;Department of Cardiology.the Second Hospital of Lanzhou University)

机构地区：[1]兰州大学第一医院心脏中心,兰州730000 [2]兰州大学第一临床医学院 [3]金昌市中西医结合医院心内科 [4]兰州大学第二医院心内科

出　　处：《临床心血管病杂志》2020年第10期930-935,共6页Journal of Clinical Cardiology

基　　金：甘肃省卫生行业科研计划项目(No:GSWSDY-2015-44);甘肃省卫生行业科研计划项目(No:GSWSDY-2015-45)。

摘　　要：目的:测定射血分数降低的心力衰竭(HFrEF)患者及正常对照者的血浆硫化氢(H2S)和可溶性ST2(sST2)的浓度,以明确血浆H2S及sST2对HFrEF的诊断价值。方法:分别收集117例HFrEF患者(心衰组)及52例健康体检者(对照组)。收集相关基线资料,采用ELISA法检测血浆H2S与sST2浓度,采用心脏超声测定左室舒张末期容积(LVEDV)、左室收缩期容积(LVESV)、左室短轴缩短率(LVFS)、左室射血分数(LVEF)。相关性分析采用Spearman检验,受试者工作特征曲线(ROC)用以评价H2S及sST2对HFrEF的诊断价值。结果:心衰组与对照组血浆H2S浓度无明显统计学差异。与对照组相比,心衰组sST2与NT-proBNP水平均显著增高(均P<0.05),且NYHA分级越高,sST2与NT-proBNP水平越高。Spearson相关性分析显示,sST2与NYHA、LVEDV、LVESV、NT-proBNP呈正相关(r=0.620、0.388、0.482、0.506,均P<0.05),与LVEF、LVFS呈负相关(r=-0.568、-0.424,均P<0.05)。ROC曲线显示,sST2诊断HFrEF的AUC为0.857(95%CI:0.789~0.926),敏感度和特异度分别为76.1%和86.5%,截点值为31.53 ng/ml。sST2与NT-proBNP联合诊断HFrEF的AUC达0.963(95%CI:0.935~0.991),敏感度和特异度分别为93.2%和94.2%。结论:HFrEF患者血浆H2S水平无明显差异,sST2水平随着NYHA分级的升高而升高,且与心功能有关。sST2与NT-proBNP联合检测可有效提高HFrEF的诊断效率。Objective:To determine the plasma hydrogen sulfide(H2S)and soluble ST2(sST2)concentrations in patients with a reduced ejection fraction of heart failure(HFrEF)and normal controls,to determine the diagnostic value of H2S and sST2 in HFrEF.Method:A total of 117 HFrEF patients(heart failure group)and 52 healthy subjects(control group)were collected.Relevant baseline data were collected,plasma H2S and sST2 concentrations were detected by ELISA,and left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular short-axis shortening rate(LVFS),and left ventricular ejection fraction(LVEF)were measured by cardiac color ultrasound.Spearman test was used for correlation analysis,receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of H2S and sST2 for HFrEF.Result:There was no significant difference in plasma H2S concentration between heart failure and control group.Compared with the control group,the levels of sST2 and NT-proBNP in heart failure group increased significantly(both P<0.05),and the higher the NYHA classification,the higher the level of sST2 and NT-proBNP.Spearson analysis showed that sST2 was positively correlated with NYHA,LVEDV,LVESV and NT-proBNP(r=0.620,0.388,0.482,0.506,all P<0.05),and negatively correlated with LVEF and LVFS(r=-0.568,-0.424,both P<0.05).ROC(AUC)in diagnosing HFrEF was 0.857(95%CI:0.789-0.926),the sensitivity and specificity were 76.1%and 86.5%,respectively,the cut-off value was 31.53 ng/ml.The AUC of sST2 combined with NT-proBNP was 0.963(95%CI:0.935-0.991),the sensitivity and specificity were 93.2%and 94.2%,respectively.Conclusion:There is no significant difference in plasma H2S in HFrEF patients.The level of sST2 increases with the increase of NYHA grade and is related to cardiac function.The combination detection of sST2 and NT-proBNP can effectively improve the diagnostic efficiency of HFrEF.

关 键 词：射血分数降低的心力衰竭 硫化氢 可溶性ST2 

分 类 号：R541.6[医药卫生—心血管疾病]