NT-proBNP联合可溶性ST2蛋白对老年慢性肾脏病合并心力衰竭病人的诊断价值

Diagnostic value of NT-proBNP combined with soluble ST2 protein for heart failure in elderly patients with chronic kidney disease

目的探讨N-末端B型脑钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-proBNP)和可溶性生长刺激表达基因2蛋白(soluble growth stimulation expressed gene 2,sST2)在老年慢性肾脏病(CKD)合并心力衰竭(HF)病人中的诊断价值。方法选取本院2018~2021年CKD住院病人269例,根据CKD-EPI公式分为4组:CKD 1期、CKD 2期、CKD 3期、CKD 4~5期,比较不同CKD分期病人血清NT-proBNP和sST2、肾功能指标、心功能指标的差异,同时分析血清sST2和NT-proBNP水平与估算的肾小球滤过率(eGFR)的相关性,并使用ROC曲线分析血清sST2和NT-proBNP诊断CKD合并HF的价值。结果在全体受试者中,血清NT-proBNP(r=-0.546,P<0.001)和sST2(r=-0.204,P=0.001)水平与eGFR呈负相关;NT-proBNP诊断CKD病人HF的界值随着肾功能分期的增加而增加,分别为:CKD 1期:407 pg/mL、CKD 2期:1211.5 pg/mL、CKD 3期:3482 pg/mL、CKD 4~5期:6512 pg/mL。在CKD 3期中,NT-proBNP联合sST2诊断CKD病人HF的AUC优于NT-proBNP单独检测,差异有统计学意义(P<0.05)。结论NT-proBNP在不同分期CKD病人中诊断HF的界值会随着肾功能的恶化而升高,需根据eGFR调整诊断界值。对于肾功能中度下降的病人,NT-proBNP、sST2二者联合检测可提高CKD病人HF的诊断准确性。

Objective To explore the diagnostic value of N-terminal pro-B-type natriuretic peptide(NT-proBNP)and soluble growth stimulation expressed gene 2(sST2)for heart failure(HF)in the elderly patients with chronic kidney disease(CKD).Methods A total of 269 hospitalized patients with CKD from 2018 to 2021 were enrolled and divided into 4 groups according to CKD stages by chronic kidney disease epidemiology collaboration(CKD-EPI)formula:CKD 1 stage,CKD 2 stage,CKD 3 stage,CKD 4-5 stage.The levels of serum NT-proBNP and sST2,renal function indexes and cardiac function indexes in the patients with different CKD stages were compared,and the correlations between serum NT-proBNP and sST2 level with estimated glomerular filtration rate(eGFR)were analyzed.The ROC curve was used to assess the value of serum sST2 and NT-proBNP in the diagnosis of HF in the elderly patients with CKD.Results Among all participants,the levels of serum NT-proBNP(r=-0.546,P<0.001)and sST2(r=-0.204,P=0.001)were negatively correlated with eGFR.The cut-off value of NT-proBNP for the diagnosis of HF in CKD patients rose with the increase of renal function stage,respectively:CKD 1 stage:407 pg/mL,CKD 2 stage:1211.5 pg/mL,CKD 3 stage:3482 pg/mL,CKD 4-5 stage:6512 pg/mL.In CKD 3 stage,the accuracy of the diagnosis of HF in CKD patients by NT-proBNP combined with sST2 was better than that by NT-proBNP alone.Conclusions The diagnostic cut-off value of NT-proBNP for HF in the patients with different stages of CKD increases with the deterioration of renal function,and the diagnostic threshold should be adjusted according to the eGFR.For the patients with moderate renal decline,the combination of NT-proBNP and sST2 can improve the diagnostic accuracy of HF.