hs-cTnT、sST2联合BNP评估射血分数降低的慢性心力衰竭的临床意义

目的: 探讨高敏肌钙蛋白T（high sensitivity troponin T,hs cTnT），血清可溶性人基质裂解素2（soluble suppression of tumorigenicity 2,sST2）及B型利钠肽（BNP）对伴有射血分数降低的慢性心力衰竭（heart failure with reduced ejection fraction,HFrEF）危险分层及预后评估的价值。方法: 收集左室射血分数（left ventricular ejection fraction,LVEF）≤40%的慢性心衰患者59例为研究组，纳入同期体检的无心力衰竭及心脏病史人群30例作为对照组。比较两组研究对象血清hs-cTnT、sST2含量，以及两者与BNP的相关性；分析研究组患者hs-cTnT、sST2、BNP含量与心功能分级、再住院率、心血管死亡发生率的相关性。结果： 研究组患者血清hs cTnT和sST2含量明显高于对照组（P均<0.001）；且均与BNP呈正相关(r=0.783、P<0.01,r=0.794、P<0.01)。hs-cTnT含量与LVEF呈负相关（Ⅱ级：r＝-0.605、P＜0.05，Ⅲ Ⅳ级：r=-0.707、P<0.05）；sST2含量与LVEF呈负相关（Ⅱ级：r＝-0.607、P＜0.05，Ⅲ-Ⅳ级：r=-0.762、P<0.05）;BNP与LVEF正相关（Ⅱ级：r＝0.505、P<0.05，Ⅲ-Ⅳ级：r=0.497、P<0.05）。院外随访6个月，hs-cTnT、sST2高值组非计划心衰再住院、心血管死亡的发生率明显高于低值组(P＜0.05)。结论： hs-cTnT、sST2联合BNP对HFrEF患者病情的严重程度及心血管事件具有良好的预测价值。

Clinical value and correlation of hs-cTnT,sST2 combined with BNP in chronic heart failure with reduced ejection fraction

Objective: To explore the clinical significance and correlationship of high sensitivity tro ponin T (hs cTnT), soluble suppression of tumorigenicity 2 (sST2) and B type natriuretic peptide (BNP) in chronic heart failure with reduced ejection fraction (HFrEF). Methods: Fifty nine patients with chronic heart failure whose left ventricular ejection fraction (LVEF) was less than 40% were enrolled in the study group.Thirty patients with no history of heart failure and heart disease were collected as control group during the same period. The serum levels of hs cTnT, sST2 and their correlation with BNP were compared between the two groups, and the levels of hs cTnT, sST2 and BNP were detected to correlate with cardiac function classification, re hospitalization rate and cardiovascular mortality rate. Results: The levels of hs cTnT and sST2 were significantly higher than those in the control group (P<0.001), and both were positively correlated with BNP(r=0.783 and 0.794, both P<0.01),respectively. The hs cTnT were negatively correlated with LVEF(Ⅱ:r＝-0.605,P<0.05;Ⅲ Ⅳ:r=-0.707,P<0.05). The sST2 were negatively correlated with LVEF(Ⅱ: r＝-0.607，P＜0.05; Ⅲ Ⅳ:r=-0.762,P<0.05), while BNP and LVEF were positively correlated（r＝0.505,P<0.05；r=0.497,P<0.05）. After six months of follow up outside hospital, the incidence of re hospitalization and cardiovascular death was significantly higher in the hs cTnT and sST2 high value groups than that in the low value group (P<0.05). Conclusion: hs cTnT, sST2 combined with BNP have a good predictive value for the severity of HFrEF patients and cardiovascular events.