即时检验(POCT)检测的sST2相关影响因素及其对心力衰竭的预后价值  

Point of Care Test for Soluble ST2 in Associated Risk Factors and Predicting the Prognosis of Heart Failure

作　　者：陈雨意 田鹏超 冯佳禹 梁琳 吴易航 黄博平 黄丽燕 赵雪梅[1] 赵朗 许天昱 周琼[1] 黄燕[1] 翟玫[1] 齐晨 张宇辉[1] 张健[1] CHEN Yuyi;TIAN Pengchao;FENG Jiayu;LIANG Lin;WU Yihang;HUANG Boping;HUANG Liyan;ZHAO Xuemei;ZHAO Lang;XU Tianyu;ZHOU Qiong;HUANG Yan;ZHAI Mei;QI Chen;ZHANG Yuhui;ZHANG Jian(Heart Failure Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心力衰竭中心,北京市100037

出　　处：《中国循环杂志》2022年第6期595-601,共7页Chinese Circulation Journal

基　　金：国家重点研发计划项目(2017YFC1308300、2017YFC1308301、2017YFC1308305);国家自然科学基金(81873472);2019年医疗服务与保障能力提升项目。

摘　　要：目的:探讨即时检验(POCT)方法检测的可溶性生长刺激表达基因2蛋白(sST2)相关影响因素及其对心力衰竭(心衰)的预后价值。方法:纳入2015年7月至2017年7月期间在中国医学科学院阜外医院心衰重症监护病房住院的心衰患者747例,采用POCT方法检测患者基线血清sST2水平。根据患者是否发生全因死亡或心脏移植分为病例组(n=231)和对照组(n=516),比较两组患者的一般临床资料,并采用多元线性回归分析分析与s ST2相关的独立预测因子。采用多因素Cox回归分析、ROC曲线、多因素Cox回归模型风险预测检验及Kaplan-Meier生存曲线评估sST2对心衰的预后价值。结果:中位随访949 d时,231例(30.9%)患者发生全因死亡或心脏移植。多元线性回归分析结果显示,高血压(T=-2.141,P=0.033)、冠心病(T=2.180,P=0.030)、NYHA心功能分级(T=2.593,P=0.010)、左心室舒张末期内径(LVEDD)(T=-3.034,P=0.003)、白蛋白(T=-2.653,P=0.008)、丙氨酸氨基转移酶(T=4.813,P=0.000)、血钠(T=-2.796,P=0.005)、尿酸(T=2.086,P=0.037)、高敏C反应蛋白(T=2.979,P=0.003)及N末端B型利钠肽原(NT-proBNP)(T=2.956,P=0.003)均是s ST2的独立预测因子。多因素Cox回归分析结果显示,基线s ST2是心衰患者发生全因死亡或心脏移植的独立预测因子[每一个单位log,校正后HR=1.36(95%CI:1.19~1.56),P<0.001]。ROC曲线分析结果显示,基线sST2对心衰患者3个月、1年及3年发生全因死亡或心脏移植均具有较好的预测价值(AUC分别为0.71、0.71及0.72),对应的基线sST2最佳截断值分别为25.28 ng/ml、27.11 ng/ml及25.28 ng/ml。多因素Cox回归模型风险预测检验结果显示,基线s ST2对心衰患者发生全因死亡或心脏移植的预测价值比基线NT-proBNP稍低,在基线NT-proBNP基础上联用基线sST2可为心衰预后评估提供额外的预测价值(P均<0.001)。分别以25 ng/ml及35 ng/ml作为s ST2的截断值,Kaplan-Meier生存曲线分析结果显示两组间的生存率差�Objectives: To investigate the point of care test(POCT) for soluble growth stimulation expressed gene 2(sST2) in associated risk factors and its value in predicting the prognosis of heart failure patients treated in the heart failure care unit.Methods: 747 consecutive patients who were admitted to heart failure care unit of Fuwai hospital and diagnosed as heart failure from July 2015 to July 2017 were enrolled. Baseline sST2 concentration was tested by POCT assay. The primary endpoint was the composite of all-cause death or heart transplantation. According to the primary endpoint events, patients were divided into two groups: event group(n=231) and control group(n=516). The general clinical characteristics of the two groups were collected and compared. Multivariate linear regression analysis was conducted to define the independent risk factors of sST2. Multivariate Cox regression analysis, receiver operating characteristic(ROC) curves, risk prediction test with multivariate Cox regression model and Kaplan-Meier analyses were conducted to investigate the relationship between sST2and prognosis of heart failure.Results: 231 patients(30.9%) suffered from all-cause death or heart transplantation during the median follow-up duration of 949 days. Multivariate linear regression analysis showed that hypertension(T=-2.141, P=0.033), coronary artery disease(T=2.180, P=0.030), NYHA functional class(T=2.593, P=0.010), left ventricular end diastolic diameter(LVEDD)(T=-3.034, P=0.003), albumin(T=-2.653, P=0.008), alanine aminotransferase(ALT)(T=4.813, P=0.000), sodium(T=-2.796,P=0.005), uric acid(UA)(T=2.086, P=0.037), high-sensitivity C-reactive protein(hs-CRP)(T=2.979, P=0.003) and N-terminal pro-B-type natriuretic peptide(NT-proBNP)(T=2.956, P=0.003) were the independent predictors of sST2. Multivariate cox regression analysis showed that baseline sST2 was the independent predictor of all-cause death or heart transplantation in patients with heart failure(per 1 log unit, adjusted HR=1.36 [95% CI: 1.19-1.56], P<0.001). ROC cu

关 键 词：可溶性生长刺激表达基因2蛋白 心力衰竭 影响因素 预后 

分 类 号：R54[医药卫生—心血管疾病]