血清sST2、NT-proBNP水平与血液透析患者发生心力衰竭的相关性分析

The Correlation Between Serum sST2,NT-proBNP Levels and Heart Failure in Hemodialysis Patients

目的观察血清可溶性st2(sST2)、N末端脑钠肽前体(NT-proBNP)表达水平与血液透析患者发生心力衰竭的相关性。方法选取在我院血液透析中心行维持性血液透析(MHD)治疗的100例慢性肾功能不全尿毒症患者,依据是否发生心力衰竭,分为并发心衰组与未并发心衰组,比较2组一般资料、透析前后血清心肌酶[肌酸激酶同工酶-MB(CK-MB)、肌钙蛋白I(cTn I)]、血肌酐(Scr)、sST2、NT-proBNP、心功能指标[心排出量(CO)、心脏指数(CI)与左室射血分数(LVEF)],比较并发心衰组不同心功能分级患者血清sST2、NT-proBNP水平,分析血清sST2、NT-proBNP对心力衰竭的预测价值。结果并发心衰组透析后CO、CI、LVEF明显低于未并发心衰组(P<0.05),且CK-MB、cTn I、sST2及NT-proBNP水平明显高于未并发心衰组(P<0.05);心力衰竭患者sST2、NT-proBNP水平为:II级<III级<IV级,比较差异显著(P<0.05);sST2预测心力衰竭灵敏度77.9%,特异性68.1%;NT-proBNP预测灵敏度91.8%,特异性92.0%。结论血液透析并发心衰患者血清sST2、NT-proBNP表达水平呈异常升高趋势,心功能越差,升高程度越大,对心力衰竭具有较高预测价值。

Objective To evaluate the correlation between expression levels of serum soluble st2(sST2)and N-terminal pro-brain natriuretic peptide(NT-proBNP)and heart failure(HF)in hemodialysis patients.Methods A total of 100 patients with chronic renal insufficiency and uremia who underwent maintenance hemodialysis(MHD)in hemodialysis center of the hospital were enrolled for the study.According to presence or absence of HF,they were divided into the HF group and non-HF group.The general data,serum myocardial enzymes[creatine kinase MB(CK-MB),cardiac troponin I(cTn I)],serum creatinine(Scr),sST2,NT-proBNP and cardiac function indexes[cardiac output(CO),cardiac index(CI),left ventricular ejection fraction(LVEF)]before and after hemodialysis were compared between the two groups.The levels of serum sST2 and NT-proBNP among patients with different cardiac function classifications in the HF group were compared.The predictive values of serum sST2 and NT-proBNP for HF were also analyzed.Results After the hemodialysis,CO,CI and LVEF in the HF group were significantly lower than those in the non-HF group(P<0.05),while levels of CK-MB,cTn I,sST2 and NT-proBNP were significantly higher than those in the non-HF group(P<0.05).When sorting levels of sST2 and NT-proBNP from low to high in HF patients,the corresponding order was grade II,III and IV(P<0.05).The sensitivity and specificity of sST2 and NT-proBNP for predicting HF were 77.9%and 68.1%,as well as 91.8%and 92.0%,respectively.Conclusion The levels of serum sST2 and NT-proBNP are abnormally increased in patients with hemodialysis complicated with HF.The worse the cardiac function,the greater the increase amplitude will be.They are of higher predictive value for HF.