可溶性ST2对慢性心力衰竭患者的诊断价值探讨

Role of soluble ST2 in the diagnosis of heart failure

目的 观察心力衰竭患者血清可溶性ST2（sST2）水平变化,分析其与射血分数、N末端脑钠肽前体（NT-proBNP）等的相关性,探讨sST2在心力衰竭诊断及危险分层中的应用价值.方法 入选2009年11月至2010年3月心力衰竭住院患者129例,按纽约心功能分级标准分为心功能Ⅱ级组66例、心功能Ⅲ级组32例、心功能Ⅳ级组31例,并收集患心脏神经症或阵发性室上性心动过速而胸部X线片、心脏彩超和心功能正常的35例作为对照组.采集入选者的临床资料,入院后行心脏彩色超声检查,测定血浆NT-proBNP水平,采用酶联免疫法测定血清sST2浓度.结果 血清sST2水平在心功能Ⅲ～Ⅳ组[1.84（0.93 ～3.19） ng/ml]显著高于心功能Ⅱ级组[0.94 （0.83 ～ 1.30） ng/ml,P＜0.001]及对照组[0.77（0.69～1.92） ng/ml,P＜0.001].sST2浓度与NT-proBNP（r=0.352）、心功能分级（r =0.456）、左心室舒张末容积（r=0.287）呈正相关（均为P＜0.001）,与左心室射血分数呈负相关（r=-0.288,P=0.016）.血清sST2诊断心力衰竭的ROC曲线下面积为0.775,NT-proBNP的ROC曲线下面积为0.889,两者联合诊断的ROC曲线下面积为0.926.结论 心力衰竭患者血清sST2水平明显升高,升高水平与心力衰竭程度显著相关.sST2有可能作为判断心力衰竭的新生化指标,联合NT-proBNP可能会提高对心力衰竭的诊断价值.sST2或可作为NT-proBNP和超声心动图外的补充手段,对心力衰竭的诊断与鉴别有一定意义.

Objective To observe the changes of serum soluble ST2 （sST2） level in patients with heart failure （HF） and to investigate the role of sST2 in evaluation of cardiac function and diagnosis of heart failure.Methods This study included 129 patients with HF hospitalized in the cardiology department of the Second Xiangya Hospital,Central South University between November 2009 and March 2010.Patients were divided into three groups according to NYHA heart function classification criterion：NYHA Class Ⅱ group （n =66）,NYHA Class Ⅲ group （n =32） and NYHA Class Ⅳ group （n =31）.Thirty five normal subjects were recruited as control group.All subjects accepted UCG examination at admission and the serum amino terminal B-type natriuretic peptide （NT-proBNP） were measured.sST2 levels were determined by enzymelinked immunosorbent assays.Results The levels of serum sST2 were significantly higher in patients with NYHA functional class Ⅲ-Ⅳ [1.84（0.93-3.19） ng/ml] than in patients with NYHA functional class Ⅱ [0.94 （0.83-1.30） ng/ml,P 〈 0.001] and in controls [0.77 （0.69-1.92） ng/ml,P 〈 0.001].Serum sST2 levels were positively correlated with NT-proBNP （r =0.352,P 〈 0.001）,NYHA functional class （r =0.456,P 〈 0.001） and left ventricular diastolic volume （r =0.287,P 〈 0.001）,and negatively correlated with left ventricular ejection fraction （LVEF） （r =-0.288,P =0.016）.Receiver-operator characteristic curves （ROC） for diagnosis of heart failure demonstrated an AUC of 0.775 for sST2,an AUC of 0.889 for NT-proBNP,and an AUC of 0.926 for combination of both biomarkers.Conclusions Serum sST2 is significantly increased in patients with HF.sST2 may be a new biomarker of HF and can provide additive value to NT-proBNP levels in the diagnosis of HF.