可溶性ST2联合NT-proBNP评估射血分数保留性心力衰竭患者的短期预后价值

Short-term prognostic value of soluble ST2 and NT-pro BNP in patients with heart failure with preserved ejection fraction

目的评估可溶性ST2(soluble ST2,sST2)联合血浆氨基末端脑钠肽前体(N-terminal pro-brain natriureticpeptide,NT-proBNP)对射血分数保留性心力衰竭(heart failure with preserved ejection fraction,HFPEF)患者短期预后的临床预测价值。方法选择128例深圳市光明新区人民医院住院的HFPEF患者,依据随访1年预后结局差异分为:研究组,共65例,随访1年发生主要心血管事件(major adverse cardiovascular events,MACE);对照组,共63例,随访1年未发生MACE。检测并比较两组的sST2、NT-proBNP、总胆固醇(total cholesterol,TC),低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)以及糖化血红蛋白(glycosylated hemoglobin,HbA_1c)浓度;应用超声心动图检测并比较两组左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end diastolic diameter,LVEDd)、E/A比值差异。应用单因素直线分析及多元Logistic回归分析对患者MACE发生率相关的危险因素进行分析,应用受试者工作特征(receiver operator char-acteristic,ROC)曲线分析sST2联合NT-proBNP的最佳预测值。结果与对照组相比,研究组的sST2、NT-proBNP、LVEDd显著较高,E/A比值明显降低,差异有统计学意义(P<0.05);而两组LVEF及HbA_1c、TC、LDL-C浓度比较,差异无统计学意义(均P>0.05)。单因素直线分析显示sST2、NT-proBNP、LVEDd、E/A比值与MACE发生率相关,多元Logistic回归分析显示sST2、NT-proBNP为MACE的独立预测因子。ROC曲线分析显示,血浆sST2≤1 505pg/m L与NT-proBNP≤3010pg/mL为预测MACE发生的最佳预测切点(曲线下面积分别为0.823、0.789,P值分别为0.026、0.017)。结论 sST2联合NT-proBNP能较好预测HFPEF患者的短期预后。

Objectives To analyze the short-term prognostic value of soluble ST2（sST2）and N-terminal pro-brainnatriuretic peptide（NT-proBNP）in patients with heart failure with preserved ejection fraction（HFPEF）. Methods Totally 128 patients with HFPEF in Shenzhen Guangming New District People′s Hospital were collected to retrospectivelystudy and divided into two groups according to prognostic outcome of one year follow-up,which were research group[65 cases,complicated with major adverse cardiovascular events（MACE）]and control group（63 cases,not compli-cated with MACE）. sST2,NT-pro BNP,total cholesterol（TC）,low density lipoprotein-cholesterol（LDL-C）and glyco-sylated hemoglobin（HbA_1c）were detected and compared between the two groups. Left ventricular ejection fraction（LVEF）,left ventricular end diastolic diameter（LVEDd） and E/A ratio were detected by ultrasonic cardiogram（UCG）and compared between the two groups. The relative risk factors to the occurrence of MACE were confirmed bysingle-factor linear analysis and multivariate Logistic analysis. The best cut-off points of sST2 and NT-proBNP wereconfirmed by the area under curve（AUC）of the receiver operator characteristic（ROC）curve. Results Compared tocontrol group,sST2,NT-proBNP and LVEDd of research group were significantly higher,and E/A ratio of researchgroup was lower（P〈0.05）,but LVEF,TC,LDL-C and Hb A1 cbetween the two groups had no significantly differences（P〉0.05）. Single-factor linear analysis indicated that sST2,NT-proBNP,LVEDd and E/A ratio relatived to occur-rence of MACE. Multivariant Logistic analysis showed that sST2 and NT-pro BNP were independent risk factors for occur-rence of MACE. Plasma concentrations of sST2≤1505pg/m L and NT-pro BNP≤3010pg/m L were the best predictedpoints to occurrence of MACE（AUC=0.823,0.789;P=0.026,0.017）. Conclusions Plasma concentrations of sST2 and NT-proBNP can predict the short-term prognosis of patients with HFPEF.