天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (1): 46-50.doi: 10.11958/20170968

• 临床研究 • 上一篇    下一篇

血清可溶性基质裂解素 2 水平与心力衰竭 严重程度及预后的关系

苏嵘 1，2，赵娜 2，齐新 2△，吴晓东 2，齐延芳 2，侯文广 2，刘克强 2   

  1. 1 天津中医药大学（邮编 300193）；2 天津市人民医院心内科
  • 收稿日期:2017-09-15 修回日期:2017-11-21 出版日期:2018-01-15 发布日期:2018-01-16
  • 通讯作者: 苏嵘 E-mail:810048761@qq.com
  • 作者简介:苏嵘（1992），女，硕士研究生，主要从事心血管疾病的发病机制方面研究
  • 基金资助:
    衰患者新型血清标志物水平与左室重构和心功能的关系;高血压病人心肾早期损害的危险分层级治疗策略的研究

The relationship between the serum level of soluble ST2 and the severity and prognosis of heart failure

SU Rong1,2, ZHAO Na2, QI Xin2△, WU Xiao-dong2, QI Yan-fang2, HOU Wen-guang2, LIU Ke-qiang   

  1. 1 Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China; 2 Department of Cardiology,Tianjin Union Medical Center
  • Received:2017-09-15 Revised:2017-11-21 Published:2018-01-15 Online:2018-01-16
  • Contact: RONG SU E-mail:810048761@qq.com
  • Supported by:
    The Relationship between the new serum markers and left ventricular remodeling and cardiac function in Heart Failure Patients;The Study on risk stratified treatment strategy of Early heart and kidney damage of hypertensive patients

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摘要： 目的 探讨血清可溶性基质裂解素 2（sST2）水平在心力衰竭患者不同分期的变化及与预后的关系。方 法 纳入处于心力衰竭 A、B、C、D 各期患者共 300 例为病例组，入选同期体检中心进行体检的老年健康人群 33 例 为对照组。收集所有观察对象的一般资料，完善心脏彩色超声检查及 sST2、氨基末端脑钠肽前体（NT-proBNP）等相 关生化指标检测，根据西雅图心力衰竭模型（SHFM）评估心力衰竭患者生存年限，并进行 1 年随访，记录临床不良事 件发生情况。结果 病例组患者 sST2 水平高于对照组，于 B 期开始升高，且随着心功能分期的发展而增加，B、C、D 期高于 A 期，D 期高于 B、C 期，差异有统计学意义（P＜0.05）；高 sST2 水平组患者的临床不良事件发生率、左室舒张 末期内径（LVEDD）、左心室质量指数（LVMI）均高于低 sST2 水平组，差异有统计学意义（P＜0.05）；不良事件组 sST2、NT-proBNP、LVEDD、LVMI 水平高于无不良事件组，左室射血分数（LVEF）、SHFM 预期寿命低于无不良事件 组，差异有统计学意义（P＜0.05）；sST2 与 LVEF 呈负相关，与 NT-proBNP、LVEDD、LVMI 呈正相关，差异有统计学意 义（P＜0.05）；sST2 用于判定心血管终点事件发生情况的 ROC 曲线下面积为 0.665（95%CI：0.574～0.757，P＜0.01）， NT-proBNP 的 ROC 曲线下面积为 0.790（95%CI：0.731～0.848，P＜0.01），sST2 预测临床不良事件的最佳 cut-off 值 为 139.27 μg/L，NT-proBNP 的最佳 cut-off 值 855.35 μg/L。结论 血清 sST2 是心力衰竭进展早期指标，其不仅反映 心室重构的严重程度，也是评估心力衰竭患者 1 年内预后的指标之一。

关键词: 心力衰竭, 心室重构, 利钠肽, 脑, 预后, N 末端 B 型利钠肽原, 可溶性 ST2

Abstract: Objective To investigate serum levels of soluble matrix lysin 2 (sST2) in patients with different stages of heart failure and its relationship with prognosis. Methods Data of 300 patients with heart failure of stages A, B, C and D were included in this study. Thirty-three cases of healthy elderly population for physical examination were used as control group. The general information, echocardiography and related biochemical tests containing sST2 and NT-proBNP were collected in the two groups. The survival periods of patients were evaluated according to the Seattle heart failure mode (SHFM). Patients were followed up for 1 year to record the occurrence of adverse events. Results The sST2 level was higher in heart failure group than that of control group. The sST2 level began to increase in stage B, and which increased with the development of cardiac function staging. The sST2 levels were significantly higher in stages B, C and D than those of stage A, and which were significantly higher in stage D than those of stages B and C (P＜0.05). There were significantly higher incidence rates of adverse events, left ventricular end diastolic diameter (LVEDD) and left ventricular mass index (LVMI) in the patients with high sST2 level than those of patients with lower sST2 level (P＜0.05). Values of sST2, NT-proBNP, LVEDD and LVMI were significantly higher, and values of LVEF and SHFM life expectancy were significantly lower, in patients with adverse events than those of patients without adverse events (P＜0.05). There was a negative correlation between sST2 and LVEF, and positive correlation between sST2 with NT-proBNP, LVEDD and LVMI (P＜0.05). The size under ROC curve, which was used to predict the cardiovascular endpoint events judged by sST2 was 0.665 (95% CI: 0.574- 0.757, P＜0.01), and the one by NT-proBNP was 0.790 (95% CI: 0.731-0.848, P＜0.01). The best cut-off value of predicting the clinical adverse events was 139.27 μg/L by sST2 and 855.35 μg/L by NT-proBNP. Conclusion The serum level of sST2 is early indicator of heart failure, which not only reflects the severity of ventricular remodeling but also is one of indicators to estimate the prognosis of heart failure in one year.

Key words: heart failure, ventricular remodeling, natriuretic peptide, brain, prognosis, NT-proBNP, sST2