射血分数保留的心力衰竭患者心功能分级与相关检验指标的关系

Relationship between cardiac function grading and relevant test indexes in patients with heart failure with preserved ejection fraction

目的探讨射血分数保留的心力衰竭(HFpEF)患者血清可溶性基质裂解素2(sST2),半乳糖凝集素-3(GAL-3),bcl-2同源结构域蛋白(Beclin-1),生长分化因子-15(GDF-15)水平与心功能分级的相关性及其对HFpEF患者的临床诊断价值。方法回顾性选择2019年1月至2020年12月崇左市人民医院收治的HFpEF患者100例,按照纽约心脏协会心功能分级标准分为心功能Ⅱ级组29例、Ⅲ级组40例和Ⅳ级组31例;另选取同期行健康体检的正常者200例作为健康对照。采集患者临床资料,对比血清氨基末端脑钠肽前体(NT-proBNP)、sST2、GAL-3、Beclin-1、GDF-15水平和左心室射血分数(LVEF)、左心房内径(LAD)、左心室舒张末期内径(LVEDd)在各组中的表达差异。Spearman分析各血清指标与心功能分级、NT-proBNP及心功能的相关性。通过ROC曲线评估sST2、GAL-3、Beclin-1、GDF-15诊断HFpEF的价值。结果不同心功能分级HFpEF组患者血清NT-proBNP、sST2、GAL-3、Beclin-1、GDF-15及LAD、LVEDd水平较对照组明显升高,且随心功能分级越高表达越高(F/H=92.204~274.140,均P<0.05)。血清sST2、GAL-3、Beclin-1、GDF-15表达与心功能分级和NT-proBNP呈正相关(r=0.768、0.813、0.712、0.789、0.659、0.774、0.682、0.732,P<0.05),与LVEF呈负相关(r=-0.574、-0.587、-0.519、-0.546,P<0.05)。NT-proBNP、sST2、GAL-3、Beclin-1、GDF-15联合诊断HFpEF的AUC为0.943,敏感度、特异度分别为90.6%、94.5%;sST2、GAL-3、Beclin-1、GDF-15联合诊断HFpEF的AUC为0.927,敏感度、特异度分别为89.2%、92.6%,联合诊断价值优于单个指标诊断。结论血清sST2、GAL-3、Beclin-1、GDF-15在HFpEF中表达明显升高,与患者心功能分级及心室重构严重程度密切相关;将以上血清指标作为NT-proBNP检测的补充可显著提高对HFpEF的诊断效能。

Objective To investigate the correlation between serum soluble matrix lysin 2(sST2),galectin-3(GAL-3),Bcl-2 homeodomain protein(beclin-1),growth differentiation factor-15(GDF-15)and cardiac function grade in patients with heart failure with preserved ejection fraction(HFpEF)and the clinical predictive diagnostic of these indexes for HFpEF.Methods A total of 100 HFpEF patients admitted to Chongzuo People’s Hospital from January 2019 to December 2020 were retrospectively selected and divided into gradeⅡgroup(n=29),gradeⅢgroup(n=40)and gradeⅣgroup(n=31)according to New York Heart Association heart function classification standard.Another 200 healthy subjects were selected as the healthy control.The clinical data of patients were collected,and the levels of serum N-terminal pro-brain natriuretic peptide(NT-proBNP),sST2,GAL-3,Beclin-1,GDF-15,left ventricular ejection fraction(LVEF),left atrial diameter(LAD)and left ventricular end-diastolic diameter(LVEDd)were compared among the groups.The correlations between serum indexes and cardiac function classification,NT-proBNP and cardiac function were analyzed by Spearman.The diagnostic value of sST2,GAL-3,Beclin-1,and GDF-15 in HFpEF was evaluated by receiver operating characteristic(ROC)curves.Results Compared with the control group,the serum levels of NT-proBNP,sST2,GAL-3,Beclin-1,GDF-15,LAD and LVEDd in HFpEF group with different cardiac function grades significantly increased,and the expressions of those indexes were higher with the increase of cardiac function grade(F/H=92.204-274.140,all P<0.05).The expressions of sST2,GAL-3,Beclin-1 and GDF-15 in serum were positively correlated with cardiac function grading and NT-proBNP(r=0.768,0.813,0.712,0.789,0.659,0.774,0.682,0.732;P<0.05),negatively correlated with LVEF(r=-0.574,-0.587,-0.519,-0.546;P<0.05).The AUC of NT-proBNP,sST2,GAL-3,Beclin-1,GDF-15 in the combined diagnosis of HFpEF was 0.943,the sensitivity and specificity were 90.6%and 94.5%,respectively.The AUC of sST2,GAL-3,Beclin-1,GDF-15 in the combined diagnosis of HFpEF was 0.927,and the sensitivity and specificity were 89.2%and 92.6%,respectively.The value of combined diagnosis was significantly better than that of single index diagnosis.Conclusion Serum sST2,GAL-3,Beclin-1 and GDF-15 significantly increased in HFpEF,which is closely related to cardiac function grade and severity of ventricular remodeling in patients.The above serum indexes can significantly improve the diagnostic efficiency of HFpEF as supplement for NT-proBNP detection.