sST2联合NT-proBNP评估ARNI干预射血分数中间值的心力衰竭患者预后价值分析

Analysis of the prognostic value of sST2 combined with NT-proBNP in evaluating ARNI intervention in heart failure patients with median ejection fraction

目的探讨可溶性生长刺激因子2(sST2)联合N末端B型利钠肽原(NT-proBNP)评估血管紧张素受体脑啡肽酶抑制剂(ARNI)沙库巴曲缬沙坦(SV)干预射血分数中间值的心力衰竭(HFmrEF)患者全因死亡和心衰再入院的预后价值。方法入选2018年10月~2020年1月于河北大学附属医院心血管内科住院的HFmrEF患者88例为研究对象,根据随访期间是否出现临床终点事件(全因死亡或心衰再入院)分为事件组(n=21)和非事件组(n=67)。搜集患者一般资料信息、入院首次超声心动图检查结果、实验室检查结果、临床合并症情况、用药情况和临床终点等资料。通过单因素Cox回归模型对可能预测HFmrEF患者预后的变量进行筛选,将单因素分析中与临床终点有统计学意义的协变量纳入多因素Cox回归模型,进而分析基线sST2和NT-proBNP对HFmrEF患者临床终点的预测价值。结果随访6~12个月期间,88例患者中全因死亡2例、心衰恶化再入院19例,被纳入事件组,其余患者67例被纳入非事件组。单因素及多因素Cox回归分析结果显示,sST2和NT-proBNP均是HFmrEF患者临床终点事件的预测因素(P均<0.05)。ROC曲线显示,sST2预测临床终点事件的AUC为0.728,最佳诊断界值为352.86 pg/ml,敏感度85.7%,特异度61.2%;NT-proBNP预测临床终点事件的AUC为0.790,最佳诊断界值为4255.00 pg/ml,敏感度100%,特异度68.7%;两者联合检测预测患者临床终点事件的价值高于任一单一指标,AUC为0.923,敏感度95.2%,特异度80.6%。结论sST2联合NT-proBNP可早期评估ARNI干预射血分数中间值的心力衰竭患者预后。

Objective To investigate the prognostic value of soluble growth stimulating expression factor 2(sST2)and N terminal pro B type natriuretic peptide(NT-proBNP)on all-cause death and heart failure rehospitalization in heat failure patients with mid-range ejection fraction(HFmrEF)with sacubitril/valsartan(SV)intervention at real world scenarios.Methods A total of 88 HFmrEF patients who were hospitalized in the Department of Cardiology of the Affiliated Hospital of Hebei University from October 2018 to January 2020 were selected as the research subjects.According to whether patients had clinical endpoint events(all-cause death or heart failure readmission)during follow-up,they were divided into event group(n=21)and non-event group(n=67).The general information of the patients,the results of the first echocardiography,laboratory examination,clinical complications,medication and clinical endpoints were collected.The univariate Cox pmportional hazard model was used to screen the variates that might predict prognosis,and then the covariates with statistical significance were included in the multivariate Cox regression model to analyze the predictive value of baseline sST2 and NT-proBNP on a11-cause death and heart failure rehospitalization.Results During the follow-up period of 6-12 months,2 of the 88 patients died from all causes,19 patients were re-admitted to hospital with worsening heart failure,and were included in the event group,while 67 patients were included in the non-event group.Univariate and multivariate Cox regression analysis results showed that both sST2 and NT-proBNP were predictors of clinical endpoint events in HFmrEF patients(both P<0.05).The ROC curve showed that the AUC of sST2 to predict the clinical endpoint event was 0.728,the best diagnostic cut-off value was 352.86 pg/ml,the sensitivity was 85.7%,and the specificity was 61.2%.The AUC of NT-proBNP predicting the clinical endpoint event is 0.790,the best diagnostic cut-off value is 4255.00 pg/ml,the sensitivity is 100%,and the specificity is 68.7%.The combined detection of the two is more valuable than any single indicator in predicting the clinical endpoint events of the patient,with an AUC of 0.923,a sensitivity of 95.2%, and a specificity of 80.6%. Conclusion sST2 combined with NT-proBNP can early evaluatethe prognosis of heart failure patients with ARNI intervention with median ejection fraction.