心力衰竭患者血清NT-proBNP和sST2水平变化及临床意义

Clinical significance of serum NT-proBNP and soluble ST2 changes in patients with heart failure

目的探讨N末端B型脑钠肽前体(NT-proBNP)和可溶性ST2(sST2)在心力衰竭(简称心衰)患者血清中的水平变化及临床意义。方法分析202例慢性心衰住院患者血清NT-proBNP、sST2水平,采用纽约心脏病学会(NYHA)标准和超声心动图检查判定患者心功能。分析比较2种生物学标志物水平在不同心功能分级患者的差异,并分析二者与NYHA心功能分级的相关性。结果两组患者血清NT-proBNP和sST2水平比较,差异均有统计学意义(P=0.001、0.002),且随NYHA分级的增加,血清NT-proBNP和sST2水平均逐渐升高。低危组患者吸烟史、左室射血分数(LVEF)、肾小球滤过率估计值(eGFR)与高危组比较,差异有统计学意义(P<0.05)。血清NT-proBNP与sST2水平成呈正相关(r=0.247,P=0.013);sST2与NYHA分级呈正相关(r=0.412,P=0.001),与LVEF呈负相关(r=-0.167,P=0.049)。NT-proBNP与NYHA分级呈正相关(r=0.536,P=0.001),与LVEF、eGFR呈负相关(r=-0.317、-0.385,P=0.001)。NT-proBNP和sST2检测评估心衰患者心功能分级的受试者工作特征曲线(ROC)的曲线下面积(AUC)分别为0.824和0.701,与NT-proBNP相比,sST2在评估慢性心衰患者心功能分级方面无明显优势,二者联合检测评估心衰患者心功能分级的AUC达0.872,灵敏度和特异度分别达76.1%和93.3%。结论血清sST2水平与NT-proBNP呈正相关,与NT-proBNP比较,sST2受肾功能影响较小,sST2联合NT-proBNP检测有助于提高心衰患者心功能分级评估,是对NT-proBNP的良好补充。

Objective To investigate N-terminal B-type natriuretic peptide and soluble suppression of tumorigenicity(sST2)levels in inpatients with chronic heart failure.Methods The serum concentrations of NT-proBNP and sST2 in 202 hospitalized patients with chronic heart failure were analyzed.The correlation between the two biomarkers and NYHA functional classifications was analyzed and the differences in the two biomarkers between the two groups were analyzed.Results The levels of NT-proBNP(P<0.001)and sST2(P=0.002)were significantly different between the two groups.The levels of NT-proBNP and sST2 gradually increased with the increase of NYHA classification.Low-risk group and high-risk group also showed statistically significant differences in smoking history,LVEF,eGFR.Spearman correlation analysis showed that there was a positive correlation between NT-proBNP and sST2 level(r=0.247,P<0.013).Spearman correlation analysis showed that sST2 was positively correlated with NYHA,and correlated negatively with LVEF.NT-proBNP was positively correlated with NYHA classification,negatively correlated with LVEF and eGFR.ROC curve analys showed that the area under the curve(AUC)of low-risk group and high-risk group with NT-proBNP and sST2 were 0.824 and 0.701,respectively.Compared with NT-proBNP,sST2 had no obvious advantage in the assessment of cardiac function in patients with chronic heart failure.The combined AUC area of the two biomarkers was 0.872,with a sensitivity and specificity of 0.761 and 0.933 respectively.Conclusion sST2 levels were positively correlated with NT-proBNP and sST2 is superior to NT-proBNP in the diagnosis of patients with heart failure who have renal dysfunction simutaneously,sST2 combined with NT-proBNP was helpful in improving heart function grading assessment in patients with heart failure.which was a good supplement of NT-proBNP.