可溶性ST2在射血分数保留的心力衰竭合并高血压患者中表达及其预后价值  

Expression of soluble ST2 and its prognostic value in patients with heart failure and hypertension with ejection fraction retention

作　　者：刘雨庭 高宇婷 侯泽 王孟薇 韩雪晶[3] 唐红霞[3] 贾克刚[1] Liu Yuting;Gao Yuting;Hou Ze;Wang Mengwei;Han Xuejing;Tang Hongxia;Jia Kegang(Clinical School of Cardiovascular Disease,Tianjin Medical University,Tianjin 300457,China;Department of Clinical Laboratory,Baoding First Central Hospital,Baoding 071000,China;Department of Clinical Laboratory,Teda International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]天津医科大学心血管病临床学院,天津300457 [2]保定市第一中心医院检验科,保定071000 [3]泰达国际心血管病医院检验科,天津300457

出　　处：《中华检验医学杂志》2023年第12期1274-1280,共7页Chinese Journal of Laboratory Medicine

基　　金：天津市泰达国际心血管病医院院级项目(2022-TD-010);天津市滨海新区卫生健康委科技项目(2022BWKZ002);天津市医学重点学科(专科)建设项目资助内科学(心血管病学)(TJYXZDXK-020A)。

摘　　要：目的探讨射血分数保留的心力衰竭(HFpEF)合并高血压患者外周血sST2水平及其与预后的关系。方法回顾性研究,连续选取2021年5月5日至2023年3月9日于泰达国际心血管病医院和保定市第一中心医院住院治疗的共122例HFpEF患者,根据是否合并高血压分为HFpEF合并高血压组73例,男32例,(67.56±12.06)岁;女41例(70.61±9.95)岁和单纯HFpEF组49例,男25例,(67.00±11.64)岁;女24例,(70.12±7.49)岁,比较两组患者外周血sST2水平;对HFpEF合并高血压患者进行高血压分级和不同预后进行分组,比较sST2在不同分组中差异性;Logistic回归进行多因素分析;ROC曲线评估sST2对HFpEF合并高血压患者不良预后辅助诊断价值。对患者定期随访,记录出院后6个月内主要不良心脏事件,包括心源性死亡、心衰再住院;通过对sST2诊断不良预后的临界值分成两组,用Kaplan-Meier进行生存分析,并用Log Rank检验;Cox回归分析随访6个月高水平sST2是否为不良预后的危险因素。结果sST2在HFpEF合并高血压组和单纯HFpEF组差异无统计学意义(P>0.05);sST2在高血压2级、3级中高于高血压1级(23.83 ng/ml比12.68 ng/ml,Z=-2.778,P=0.005;22.54 ng/ml比12.68 ng/ml,Z=-2.865,P=0.004);BNP在高血压3级中高于高血压1级(582.95 pg/ml比154.50 pg/ml,Z=-2.101,P<0.05);sST2和BNP在预后不良组中高于预后良好组(30.10 ng/ml比18.95 ng/ml,Z=-2.803;685.00 pg/ml比347.50 pg/ml,Z=-2.385),P均<0.05;Logistic回归分析显示sST2是不良预后的危险因素(OR=1.045,P=0.013);ROC曲线分析sST2水平对HFpEF合并高血压患者不良预后的辅助诊断价值(AUC为0.721,P<0.05);随访6个月内sST2>29.12组心脏不良事件发生率高于sST2≤29.12组(44.00%比14.58%),差异有统计学意义(χ^(2)=7.657,P=0.006);Kaplan-Meier生存分析结果显示sST2≤29.12组的未发生终点事件的患者比率高于sST2>29.12组(P=0.003)。Cox回归分析结果显示sST2>29.12组发生终点事件风险是sST2≤29.12组的3.879倍(OR=3.879,PObjective To investigate the relationship between peripheral blood sST2 level and prognosis in patients with heart failure(HFpEF)complicated with hypertension with ejection fraction preservation.Methods A total of 122 patients with HFpEF hospitalized in Teda International Cardiovascular Hospital and Baoding First Central Hospital from May 5,2021 to March 9,2023 were selected.According to whether they were combined with hypertension,they were divided into HFpEF combined with hypertension group(73 cases,32 males,(67.56±12.06)years old).There were 41 females(70.61±9.95 years old)and 49 males(67.00±11.64 years old)in the HFpEF group alone.There were 24 female patients(70.12±7.49 years old).sST2 levels in peripheral blood were compared between the two groups.HFpEF patients with hypertension were grouped by hypertension grade and prognosis,and the difference of sST2 in different groups was compared.Logistic regression was used for multivariate analysis.ROC curve to evaluate the diagnostic value of sST2 in the poor prognosis of HFpEF patients with hypertension.Patients were followed up regularly and major adverse cardiac events were recorded within 6 months after discharge,including cardiogenic death and heart failure re-hospitalization.The critical value of poor prognosis diagnosed by sST2 was divided into two groups,survival analysis was performed by Kaplan-Meier,and the Log Rank test was performed.Cox regression analysis was performed to determine whether high levels of sST2 were a risk factor for poor prognosis after 6 months of follow-up.Results There was no significant difference in sST2 in HFpEF combined with hypertension and HFpEF alone(P>0.05).sST2 was higher in grade 2 and 3 than in grade 1 hypertension(23.83 ng/ml vs.12.68 ng/ml,Z=-2.778,P=0.005;22.54 ng/ml vs.12.68 ng/ml,Z=-2.865,P=0.004);BNP was higher in grade 3 hypertension than in grade 1 hypertension(582.95 pg/ml vs.154.50 pg/ml,Z=-2.101,P<0.05).sST2 and BNP were higher in the poor prognosis group than in the good prognosis group(30.10 ng/ml vs.18.9

关 键 词：心力衰竭 可溶性ST2 心血管事件 

分 类 号：R541.6[医药卫生—心血管疾病] R544.1[医药卫生—内科学]