心肌纤维化血清学指标对优化心功能分级及预测心力衰竭预后的临床意义

Clinical significance of myocardial fibrosis serological parameters in optimizing cardiac function classification and predicting prognosis of heart failure

目的通过对比分析心肌纤维化血清学指标对优化心功能分级及预测心力衰竭预后临床意义的研究,为心力衰竭的治疗提供理论依据。方法选取自2014年4月至2016年4月入住首都医科大学宣武医院的223例心力衰竭患者为研究对象,按照纽约心脏协会(New York Hear Assocation,NYHA)心功能分级标准分为心功能Ⅰ~Ⅳ级4组,比较各组血清指标对优化心功能分级及预测心力衰竭预后的效果。结果 4组患者之间随着心功能分级增加,左心室射血分数逐渐减小,左心室舒张末期内径逐渐增大,差异有统计学意义(P<0.05);4组患者随着心功能分级增加,可溶性ST2(soluble ST2,sST2)浓度由(14.33±7.63)ng/m L增加到(58.69±35.64)ng/mL,半乳糖凝集素-3浓度由(12.96±5.02)ng/mL增加到(18.23±7.69)ng/mL,各组之间相比差异有统计学意义(P<0.05)。sST2和半乳糖凝集素-3有较强的相关性(r=0.356,P<0.001);sST2与左心室射血分数有较强的负相关性(r=-0.341,P<0.001)。sST2对心力衰竭预后敏感度和特异性分别为82.6%、98.4%,半乳糖凝集素-3对心力衰竭预后敏感度和特异性分别为67.8%、65.9%,均有统计学意义(P<0.05)。结论血清sST2、半乳糖凝集素-3浓度与心功能分级呈正相关,能准确反映患者心功能状态及预测心力衰竭预后。

Objectives To provide a theoretical basis for the management of heart failure by comparing serum markersof myocardial fibrosis to optimize the classification of cardiac function and predict the prognosis of heart failure.Methods Totally 223 patients with heart failure from April 2014 to April 2016 in Xuanwu Hospital of Capital MedicalUniversity were selected as object of study. According to New York Hear Assocation（NYHA）classification criteria forcardiac function,the patients were divided into Ⅰ-Ⅳ grade groups. Effects of serum indexes on the classification ofheart function and predicting the prognosis of heart failure were compared among the 4 groups. Results Left ventricularejection fraction decreased gradually with the increasing of cardiac function grade,and diameter of left ventricular enddiastolic diameter increased gradually,the differences were statistically significant（P〈0.05）. With cardiac functiongrade increased,concentrations of ST2 increased from（14.33±7.63）ng/mL to（58.69±35.6）ng/mL in patients of the4 groups;concentrations of Galectin-3 increased from（12.96±5.02）ng/mL to（18.23±7.69）ng/mL,differencesamomg the 4 groups were statistically significant（P〈0.05）. Serum concentrations of sST2 strongly correlated withGalectin-3（r=0.356,P〈0.001）;serum concentrations of sST2 negatively correlated with left ventricular ejection frac-tion（r=-0.341,P〈0.001）. Sensitivity and specificity of sST2 on the prognosis of heart failure were 82.6%,98.4%（P〈0.005）. Sensitivity and specificity of Galectin-3 on the prognosis of heart failure were 67.8%,65.9%（P〈0.05）.Conclusions Serum concentrations of sST2,Galectin-3 are positively correlated with cardiac function grade,whichcan accurately reflect the cardiac function status and predict the prognosis of heart failure.