超声心动图参数联合血清可溶性基质裂解素2水平对老年慢性心力衰竭患者预后不良的预测价值

Prognostic value of the combination of echocardiographic parameters and serum soluble suppression of tumorigenicity 2 level in elderly patients with chronic heart failure

目的 分析超声心动图参数联合血清可溶性基质裂解素2(sST2)水平对老年慢性心力衰竭患者预后不良的预测价值。方法 选取自贡市第一人民医院2018年7月至2020年5月收治的116例老年慢性心力衰竭患者为观察组,随机选取同期109例健康体检者为对照组。观察组出院后随访6个月,根据有无预后不良事件分为预后不良组44例及预后良好组72例。对比出院前观察组与对照组以及预后不良组与预后良好组超声心动图参数以及血清sST2水平,用Logistic回归分析探讨超声心动图参数、血清sST2水平与老年慢性心力衰竭患者预后不良的关系,绘制ROC曲线分析不同指标对老年慢性心力衰竭患者预后不良的预测效能。结果 观察组左心室舒张末期直径(LVEDD)、左心室收缩末期直径(LVESD)、血清sST2水平均高于对照组(U=23.879、27.442、51.991,P <0.05),左心室射血分数(LVEF)低于对照组(U=40.609,P <0.05);观察组出院后6个月内预后不良发生率为37.93%,预后不良组LVEDD、LVESD、血清sST2水平均高于预后良好组(U=6.009、7.991、6.812,P <0.05),LVEF低于预后良好组(U=8.880,P <0.05);病程>8年、退行性心脏瓣膜病、LVEDD、LVESD、LVEF、sST2均是老年慢性心力衰竭患者预后不良的独立危险因素[OR(95%CI)=5.836(4.812~6.074)、4.384(3.485~4.697)、7.501(6.715~8.012)、6.443(5.974~7.335)、7.933(7.188~8.241)、6.973(5.063~7.500),P <0.05];超声心动图参数联合血清sST2水平预测观察组预后不良的AUC高于单独预测(P <0.05)。结论超声心动图参数联合血清sST2水平对老年慢性心力衰竭患者预后不良的预测效能高。

Objective To analyze the predictive value of the combination of echocardiographic parameters and serum soluble suppression of tumorigenicity 2(sST2) level in poor prognosis of elderly patients with chronic heart failure. Methods 116 cases of elderly patients with chronic heart failure in Zigong First People’s Hospital from July 2018 to May 2020 were selected as the observation group,and 109 cases of healthy people in the same period were randomly selected as the control group. The observation group was followed up for 6 months after discharge. According to the presence or absence of adverse events, the observation group was divided into poor prognosis group(44 cases) and good prognosis group(72 cases). The echocardiographic indexes and serum sST2 level were compared between the observation group and the control group before discharge, as well as the poor prognosis group and good prognosis group. Logistic regression analysis was used to explore the relationship between echocardiographic parameters, serum sST2 level and poor prognosis in elderly patients with chronic heart failure. Receiver operating characteristic(ROC) curve was drawn to analyze the predictive effects of different indicators on poor prognosis of elderly patients with chronic heart failure. Results The left ventricular end diastolic diameter(LVEDD), left ventricular end systolic diameter(LVESD) and serum sST2 level in the observation group were higher than those in the control group(U=23.879, 27.442,51.991;P < 0.05), and left ventricular ejection fraction(LVEF) in the observation group was lower than that in the control group(U=40.609, P < 0.05). The incidence of poor prognosis in the observation group was 37.93% within 6 months after discharge. The levels of LVEDD, LVESD and serum s ST2 level in poor prognosis group were higher than those in good prognosis group(U=6.009, 7.991, 6.812;P < 0.05), and LVEF was lower than that in good prognosis group(U=8.880, P < 0.05). Course of disease > 8 years, degenerative valvular heart disease, LVEDD, LVESD, LVEF and s ST2 were independent risk factors for poor prognosis in elderly patients with chronic heart failure [OR(95%CI)=5.836(4.812-6.074), 4.384(3.485-4.697), 7.501(6.715-8.012), 6.443(5.974-7.335), 7.933(7.188-8.241), 6.973(5.063-7.500);P < 0.05]. The AUC of poor prognosis in the observation group predicted by echocardiographic parameters combined with serum s ST2 level was higher than those predicted alone(P < 0.05). Conclusion Echocardiographic parameters combined with serum s ST2 level has high predictive effect on poor prognosis in elderly patients with chronic heart failure.