肾上腺髓质素与ST2在心力衰竭患者中的诊断价值

目的 探讨肾上腺髓质素(ADM)与可溶性基质溶素-2(ST2)对心力衰竭(心衰)检测的临床意义。 方法 选取2016年6月-2017年1月收治的心血管疾病患者86例,根据超声心动图检测结果分为心衰组与心功能代偿组。单因素分析比较2组患者的基线资料及ST2,ADM,B型利钠肽(BNP)等指标的差异,筛选存在统计学意义的因素; 多因素Logistic回归进一步探索对心衰检测存在影响作用的因素; 分析各变量之间的相关性,ROC曲线分析其对心衰患者的诊断价值。 结果 心衰组与心功能代偿组患者在体质量指数(BMI),ST2,ADM,BNP和高敏C反应蛋白(hs-CRP)水平的差别均有统计学意义(P<0.05)。多因素Logistic分析结果显示,血清ADM水平(P=0.046)、ST2水平(P=0.034)和BNP(P=0.007)对心衰诊断存在显著影响,且BNP的影响程度最高(OR=2.361)。Pearson相关性分析提示,ADM(r=0.442)、ST2(r=0.506)与BNP呈正相关关系,差别有统计学意义(P<0.05)。ROC曲线提示,ST2联合BNP、ST2联合ADM、BNP联合ADM在ROC曲线下面积(AUC)分别为0.853,0.701及0.756,三者相比,ST2联合BNP的AUC最高,敏感度为84.8%,特异性为70%。 结论 ST2联合BNP可在一定程度上检测出心衰的存在,从而为早期心衰的进一步诊断提供理论依据。

Diagnostic Value of Adrenomedullin and ST2 in Patients with Heart Failure

ABSTRACT: Objective To investigate the clinical value of adrenomedullin(ADM)and soluble matrix lysine-2(ST2)in the detection of heart failure and their clinical significance. Methods A total of 86 patients with cardiovascular diseases in our hospital from June 2016 to January 2017 were selected and divided into heart failure group and cardiac function compensation group according to echocardiography results. Univariate analysis was used to compare baseline data, ST2, ADM, and B-type natriuretic peptide(BNP)levels between the two groups and the factors with statistical significance were selected. Logistic regression was applied to further explore the factors affecting heart failure. The correlation between variables was analyzed. The diagnostic value was calculated by ROC curve analysis. Results There were significant differences in the levels of BMI, ST2, ADM, BNP, and hypersensitive C-reactive protein(hs-CRP)between the heart failure group and the cardiac function compensation group(P<0.05). Multivariate logistic analysis showed that ST2(P=0.034), ADM(P=0.046), and BNP(P=0.007)had a significant impact on the detection of heart failure, and the influence of BNP was the highest(OR=2.361). Pearson correlation analysis showed that ADM(r=0.442)and ST2(r=0.506)were statistically positively correlated with BNP(P<0.05). The ROC curve indicated that the area under the ROC curve of ST2 combined with BNP, ST2 combined with ADM, and BNP combined with ADM were 0.853, 0.701, 0.756, respectively. The AUC of ST2 combined with BNP was highest and their sensitivity was 84.8% and specificity was 70%. Conclusion ST2 combined with BNP can detect the presence of heart failure in a certain extent, and has a certain clinical diagnostic value, which provides a theoretical basis for further diagnosis of early heart failure.