血清可溶性ST2在慢性心力衰竭急性失代偿早期诊断和近期预后评估中的作用

doi:DOI:10.3969/j.issn.1001-9057.2019.04.010

摘要/Abstract

摘要： 目的探讨血清可溶性ST2在慢性心力衰竭急性失代偿(ADHF)早期诊断及近期预后评估中的作用。方法纳入ADHF患者60例(观察组)和慢性心力衰竭稳定期患者60例(对照组)，分别检测并比较两组患者的血清可溶性ST2和血浆氨基末端脑钠肽前体(NT-ProBNP)水平等指标。采用Pearson相关分析评估ADHF患者血清可溶性ST2水平与其他指标的相关性。采用受试者工作特征(ROC)曲线分析血清可溶性ST2和NT-proBNP对ADHF的诊断效能。结果观察组患者心率、血压、急性生理与慢性健康评分(APACHE Ⅱ评分)、可溶性ST2、NT-proBNP、血肌酐均高于对照组，左心室射血分数(LVEF)低于对照组，两组患者纽约心脏病协会(NYHA)心功能分级构成比比较差异有统计学意义(P<0.05)。Pearson相关分析结果显示，ADHF患者血清可溶性ST2水平与心率、收缩压、舒张压、APACHE Ⅱ评分、NYHA心功能分级、NT-proBNP及血肌酐均呈正相关，与LVEF呈负相关(P<0.05)。血清可溶性ST2和NT-proBNP诊断ADHF的AUC分别为0.800、0.780，差异无统计学意义(P＝0.894)。56例转至慢性心力衰竭稳定期的患者治疗前血清可溶性ST2水平高于治疗后(P＜0.001)。结论血清可溶性ST2在ADHF早期诊断中具有一定价值，其水平与病情严重程度密切相关，有望成为评估ADHF患者近期预后的生物学标志物。

关键词: 慢性心力衰竭急性失代偿; 可溶性ST2; 氨基末端脑钠肽前体; 诊断; 预后

Abstract: Objective To explore the effect of serum soluble ST2 in early diagnosis and short-term prognosis evaluation of acute decompensation of chronic heart failure(ADHF).Methods Sixty patients with ADHF(observation group) and 60 patients with stable chronic heart failure(control group) were concluded.Levels of serum soluble ST2 and plasma amino terminal brain natriuretic peptide(NT-proBNP) were detected and compared between the two groups.Correlations between level of serum soluble ST2 and other indexes in patients with ADHF were evaluated by Pearson correlation analysis.Diagnostic efficacy of serum soluble ST2 and NT-proBNP on ADHF were analyzed by receiver operating characteristic(ROC) curve.Results Heart rate,blood pressure,acute physiology and chronic health score(APACHE Ⅱ score),soluble ST2,NT-proBNP and serum creatinine were higher in observation group than those in control group,left ventricular ejection fraction(LVEF) was lower than that in control group,and there was significant difference of constituent ratio of New York Heart Association(NYHA) heart function classification between the two groups(P<0.05).Pearson correlation analysis showed that level of serum soluble ST2 in ADHF patients were positively correlated with heart rate,systolic blood pressure,diastolic blood pressure,APACHE Ⅱ score,NYHA heart function classification,NT-proBNP and serum creatinine,and negatively correlated with LVEF(P<0.05).AUC of serum soluble ST2 and NT-proBNP for the diagnosis of ADHF were 0.800 and 0.780 respectively,and the difference was not statistically significant(P=0.894).Level of serum soluble ST2 before treatment was significantly higher than that after treatment in 56 patients who turned to stable chronic heart failure(P<0.001).Conclusion There is certain value of serum soluble ST2 in early diagnosis of ADHF,and its level is closely related with severity of disease.Serum soluble ST2 is expected to be a biomarker for evaluating short-term prognosis of patients with ADHF.

Key words: Acute decompensation of chronic heart failure; Soluble ST2; Amino terminal brain natriuretic peptide; Diagnosis; Prognosis

尹坤, 张武, 向睿. 血清可溶性ST2在慢性心力衰竭急性失代偿早期诊断和近期预后评估中的作用[J]. 临床内科杂志, 2019, 36(4): 250-253.

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血清可溶性ST2在慢性心力衰竭急性失代偿早期诊断和近期预后评估中的作用

Effect of serum soluble ST in early diagnosis and short-term prognosis evaluation of acute decompensation of chronic heart failure

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