血清Ⅲ型前胶原氨基端肽及可溶性生长刺激表达基因2蛋白在慢性稳定性心力衰竭与急性失代偿性心力衰竭患者中的临床意义

Clinical significance of serum procollagen Ⅲ amino N-terminal peptide and soluble growth stimulation expressed gene 2 in patients with chronic stable heart failure and acute decompensated heart failure

目的探讨慢性稳定性心力衰竭与急性失代偿性心力衰竭患者的血清Ⅲ型前胶原氨基端肽(PⅢNP)及可溶性生长刺激表达基因2蛋白(sST2)表达差异及其对患者预后的预测效能。方法选取廊坊市中医医院收治的慢性心力衰竭(CHF)患者320例,其中急性失代偿性心力衰竭患者(失代偿组)108例,慢性稳定性心力衰竭患者(稳定组)212例,比较两组血清PⅢNP、sST2等指标。随访6个月,记录患者的不良预后事件发生情况,根据随访结果分为预后良好组117例和预后不良组203例,分析血清PⅢNP、sST2对患者不良预后事件的预测效能。结果失代偿组的PⅢNP、sST2、N末端脑钠肽前体(NT-proBNP)水平均显著高于稳定组,左心室射血分数(LVEF)水平显著低于稳定组(t=14.621、8.065、23.958、10.497,P<0.05)。失代偿组及稳定组患者PⅢNP、sST2与心率、急性生理学及慢性健康状况评分系统Ⅱ评分、NYHA心功能分级、收缩压、舒张压、NT-proBNP均呈正相关,与LVEF呈负相关(P<0.05)。失代偿组预后不良率明显高于稳定组(χ^(2)=27.822,P<0.05)。与预后良好组相比,预后不良组患者的PⅢNP、sST2、NT-proBNP及左心室舒张末期内径水平均明显更高,LVEF水平明显更低(t=8.426、5.905、15.105、9.201、10.348,P<0.05)。ROC曲线显示PⅢNP、sST2的AUC分别为0.810、0.785,敏感度分别为78.2%和77.5%,特异度分别为80.3%和67.3%。结论慢性稳定性心力衰竭与急性失代偿性心力衰竭患者的血清PⅢNP、sST2表达差异显著,PⅢNP、sST2对CHF患者预后不良有一定的预测价值。

Objective To investigate the difference of serum procollagenⅢN-terminal peptide(PⅢNP)and soluble growth stimulation expressed gene 2(sST2)expression in patients with chronic stable heart failure and acute decompensated heart failure and the predictive effect on prognosis.Methods A total of 320 patients with chronic heart failure(CHF)in Langfang Traditional Chinese Medicine Hospital were selected,including 108 cases of acute decompensated heart failure(decompensated group)and 212 cases of chronic stable heart failure(stable group).Serum PⅢNP and sST2 in both groups were measured.The patients were followed up for 6 months and the occurrence of adverse prognostic events was recorded.According to the follow-up results,the patients were divided into good prognosis group(117 cases)and bad prognosis group(203 cases).The predictive efficacy of serum PⅢNP and sST2 on adverse prognostic events was analyzed.Results The levels of PⅢNP,sST2 and N-terminal brain natriuretic peptide precursor(NT-proBNP)in decompensated group were significantly higher than those in stable group,and the level of left ventricular ejection fraction(LVEF)was significantly lower than that in stable group(t=14.621,8.065,23.958,10.497;P<0.05).PⅢNP and sST2 in decompensated group and stable group were positively correlated with heart rate,Acute Physiology and Chronic Health EvaluationⅡscore,New York Heart Association cardiac functional grade,systolic blood pressure,diastolic blood pressure and NT-proBNP,and negatively correlated with LVEF(P<0.05).The rate of poor prognosis in decompensated group was significantly higher than that in stable group(χ^(2)=27.822,P<0.05).Compared with the good prognosis group,the levels of PⅢNP,sST2,NT-proBNP and left ventricular end-diastolic dimension in the poor prognosis group were significantly higher,and the level of LVEF was significantly lower(t=8.426,5.905,15.105,9.201,10.348;P<0.05).ROC curve showed that the AUC of PⅢNP and sST2 were 0.810 and 0.785 respectively,and the sensitivity was 78.2%and 77.5%respectively,the specificity was 80.3%and 67.3%respectively.Conclusion The serum PⅢNP and sST2 expression in patients with chronic stable heart failure and acute decompensated heart failure were significantly different.PⅢNP and sST2 have certain predictive value for poor prognosis in patients with CHF.