心力衰竭患者血清NT-proBNP与可溶性ST2联合应用对住院死亡及1年全因死亡价值分析

Value of N-terminal pro-brain natriuretic peptide combined with soluble growth stimulation expressed gene 2 to hospitalization death and all-cause death in patients with heart failure

目的评价心力衰竭(心衰)患者血清N末端脑钠肽前体(NT-proBNP)及可溶性刺激生长因子基因表达2蛋白(sST2)两种标记物联合应用在住院死亡、1年全因死亡危险分层中的价值。方法选择2019年3月至2022年12月于海口市人民医院以心力衰竭为主要原因就诊患者900例。测定患者入院时NT-proBNP与sST2水平。随访1年,终点事件为住院死亡及1年全因死亡。结果入选患者中38例住院死亡,139例于1年内死亡。根据患者基线sST2与NT-proBNP中位数水平将患者分为:A组(NT-proBNP低+sST2低)、B组(NT-proBNP高+sST2低)、C组(NT-proBNP低+sST2高)、D组(NT-proBNP高+sST2高)。B组与C组患者相比年龄、扩张型心肌病比例、估测肾小球滤过率<60 ml/min·1.73 m2比例、左室舒张末内径及血钠水平明显增高(P<0.05),心房颤动发生比例、感染发生比例、左室射血分数水平、白细胞计数及血红蛋白水平明显减低(P<0.05)。多因素Cox回归分析显示D组患者与A组患者相比住院死亡风险(HR=4.515,95%CI:1.288~15.602,P=0.018)明显增加;D组患者1年死亡风险最高,是A组的5.736倍(95%CI:3.114~10.396,P<0.001),其次为B组与C组患者。结论不同NT-proBNP及sST2水平心力衰竭患者临床特点存在差异。两种标记物联合可分析心力衰竭患者住院死亡及1年死亡的风险分层价值。

Objective To review the value of N-terminal pro-brain natriuretic peptide(NT-proBNP)combined withsoluble growth stimulation expressed gene 2(sST2)to risk stratification of hospitalization death and 1-y all-cause death in patients with heart failure(HF).Methods HF patients(n=900)were chosen from People’s Hospital of Haikou City from Mar.2019 to Dec.2022.The levels of NT-proBNP and sST2 were detected when patients admitted.The patients were followed up for 1 y,and end-point events were hospitalization death and 1-y all-cause death.Results Of all selected patients,there were 38 died during hospitalization and 139 died within 1 y.According to baseline median levels of sST2 and NT-proBNP,the patients were divided into group A(low NT-proBNP+low sST2),group B(high NT-proBNP+low sST2),group C(low NT-proBNP+high sST2)and group D(high NT-proBNP+high sST2).Compared with group C,in group B age,percentages of dilated cardiomyopathy(DCM)and estimated glomerular filtration rate(eGFR)<60 ml/min·1.73 m2,left ventricular end-diastolic diameter(LVEDd)and blood sodium level increased significantly(P<0.05),and percentages of atrial fibrillation(AF)and infection,and levels of left ventricular ejection fraction(LVEF),white blood cell count(WBC)and hemoglobin(Hb)decreased significantly(P<0.05).The results of multi-factor Cox regression analysis showed that hospitalization death risk increased significantly in group D compared with group A(HR=4.515,95%CI:1.288~15.602,P=0.018).The risk of 1-y all-cause death was the highest in group D,which was 5.736 times higher than group A(95%CI:3.114~10.396,P<0.001),followed by group B.Conclusion There are differences in clinical characteristics in HF patients with different levels of NT-proBNP and sST2.NT-proBNP combined with sST2 can be used to analyze the risk stratification of hospitalization death and 1-y all-cause death in HF patients.