sST2蛋白与维持性血透合并心力衰竭患者短期预后的相关性分析

Correlation Analysis between sST2 and Short-term Prognosis in Maintenance Hemodialysis Patients Combined with Heart Failure

目的:回顾性分析可溶性生长刺激表达基因2(sST2)蛋白血清水平与维持性血透合并心力衰竭(HF)患者短期预后的相关性。方法:选取2016-01—2017-12在本院血透中心行维持性血透且病历资料完整患者作为观察组(n=86),并按HF患者左室射血分数(LVEF)不同分为LVEF降低HF组(HFrEF组,n=22)、LVEF中间范围HF组(HFmrEF组,n=26)和LVEF保留HF组(HFpEF组,n=38),另选同期年龄和性别匹配的体检健康者作为对照组(n=20)。采用ELISA检测各组血清sST2、氨基末端脑钠肽前体(NT pro-BNP)水平,收集病历资料中性别、年龄、血压、血脂、血红蛋白、血浆白蛋白、血肌酐、心肌肌钙蛋白(TNI)、脑钠肽(BNP)、LVEF、左室舒张末内径等数据,比较观察组与对照组,以及观察组中不同类型HF组有关指标的分布差异。并对观察组随访1年后,以患者是否出现HF再入院或因心血管事件死亡等终点事件分为事件组(n=28)和非事件组(n=58)。分析sST2等因素与患者终点事件发生的相关性及独立预测意义。结果:与对照组相比,观察组sST2、NT pro-BNP及BNP均明显升高(P<0.01),不同心衰组血浆白蛋白、sST2、BNP、LVEF、左室舒张末期内径和TNI水平差异有统计学意义(P<0.05或P<0.01);单因素Spearman相关性分析表明年龄越大, sST2、BNP水平越高,患者终点事件的发生越多,呈明显正相关(P<0.05或P<0.01),而LVEF越高,终点事件发生越少,两者呈明显负相关(P<0.01);Logistic回归分析显示LVEF、sST2对血透患者1年内因HF再次入院或因心血管事件死亡有独立预测意义(P<0.05或P<0.01)。结论:sST2与其它心衰标志物类似,与维持性血透合并HF患者终点事件的发生存在相关性,而且与LVEF一起对患者终点事件具有预测价值。

Objective:To retrospectively analyze the correlation between the serum level of soluble growth stimulating express gene 2(sST2)and the short-term prognosis in maintenance hemodialysis patients combined with heart failure.Method:Maintenance hemodialysis patients in our hemodialysis center with intact medical records(n=86)were enrolled from January 2016 to December 2017.According to the left ventricular ejection fraction(LVEF),hemodialysis patients were divided into heart failure with reduced ejection fraction group(HFrEF group,n=22),heart failure with mid-range ejection fraction group(HFmrEF group,n=26),and heart failure with preserved ejection fraction group(HFpEF group,n=38).Meanwhile,healthy person with age and gender matched were selected as a control group(n=20).The levels of serum sST2,N-terminal pro-B-type natriuretic peptide(NT pro-BNP)and brain natriuretic peptide(BNP)were measured by ELISA.The records of gender,age,blood pressure,blood lipid,hemoglobin,plasma albumin,serum creatinine,troponin I(TNI),LVEF,Left ventricular end diastolic diameter(LVEDD)were collected and analyzed in observation groups and control group.According to re-hospitalization or death for cardiovascular causes in one-year follow-up,the maintenance hemodialysis patients with heart failure were divided into endpoint event group(n=28)and non-endpoint event group(n=58).The correlation between clinical parameters and the occurrence of end-point events in hemodialysis patients were analyzed by Univariate Spearman correlation analysis.Logistic regression analysis was performed to identify independent predictive factors for cardiac end-point events.Results:Compared with the control group,the serum levels of sST2,NT pro-BNP and BNP were significantly increased in the observation group(P<0.01).The differences of plasma albumin,LVEF,LVEDD,TNI,sST2 and BNP levels in observation groups were statistically significant(P<0.05 or P<0.01);Univariate Spearman correlation analysis showed that age,sST2 and BNP levels were positively correlated with occurrence of cardiac end-point events(P<0.05 or P<0.01),but negatively correlated with LVEF(P<0.01).Logistic regression analysis showed that LVEF and sST2 had independent predictive value for appearance of cardiac end-point events in hemodialysis patients with heart failure(P<0.05 or P<0.01).Conclusion:sST2 is associated with the cardiac death or re-hospitalization in maintenance hemodialysis patients,which has predictive value for cardiac end-point events with LVEF.