血清可溶性ST2评价老年急性心力衰竭患者病情与预后的研究

目的 观察与讨论血清可溶性ST2(sST2)浓度在老年急性心力衰竭(AHF)病情严重程度以及预后评估中的价值.方法 选取AHF患者75例,并收集38例正常查体人员为对照,所有病例随访1年,记录患者生存是否或再次因心衰入院.临床资料应用SPSS19.0软件进行统计处理.结果 sST2 (pg/mL)在AHF组中较正常对照有明显升高(1 698.9±797.0 vs 596.9±181.2,P＜0.01),sST2水平在不同心功能临床分级(轻组-Ⅰ和Ⅱ级,重组-Ⅲ和Ⅳ级)间比较差异具有统计学意义(1439.5±694.5) vs.(2 057.8±1 428.6),P=0.026];75例AHF患者中,发生终点不良事件组sST2明显高于非事件组(2234.4±1 308.5) vs.(1 162.3±452.6),P=0.000].经独立危险因素非条件logistic二元回归模型分析,sST2、NT-proBNP和心功能临床分级三个协变量对AHF预后有独立预测意义,OR值分别为1.003、1.001、7.46;以sST2 1 760 pg/mL为cutoff值评估不良预后,其敏感性为64％、特异性为92％、阳性预测率89％,阴性预测率70％,正确率77％;若联合NT-proBNP评估预后,则结果更优,ROC曲线下面积为0.889.结论 sST2在老年AHF患者入院早期即有显著升高,并且随心功能临床分级而相应升高,提示sST2水平可评价AHF病情严重程度;发生心血管不良事件的AHF患者的sST2水平明显高于无事件发生者,表明sST2可以评估AHF患者的预后;若结合NT-proBNP等相关生物学标记物,sST2可以更好地进行危险分层和预后评估.

The predicting value of serum sST2 on condition and prognosis in elderly patients with acute heart failure

Objective To investigate the predicting value of serum sST2 on risk stratification and prognosis in elderly patients with acute heart failure (AHF).Methods Total of 75 AHF patients aged 60 to 93 were selected in our study who were in Beijing Hospital during 2013.1-2014.8,including 40 cases of male and 35 cases of female.Moreover,38 healthy people aged 70 to 80 were chosen as control group,which contains 18 cases of male and 20 cases of female.Follow-up was performed 1 year after acute attack.We defined the end of observation as recurrence of heart failure or any causes of death.The data was analyzed by SPSS19.0.Results Compared with control group,sST2 level (pg/mL) was significantly elevated in AHF group (596.9 ±181.2) vs.(1 698.9 ±797.0),P ＜0.001].No significant difference was found between male and female (1 713.1 ± 1 322.2 vs.1 727.5 ±867.1,P =0.956).sST2 level was significantly different between patients with different clinical heart function grade 1 439.5 ±694.5 (mild-Ⅰ and Ⅱ grade) vs.2 057.8 ± 1428.6 (severeⅢ and Ⅳ grade),P =0.026].Among the 75 AHF patients,sST2 level was higher in patients with endpoint events than those without endpoint events (2 234.4 ± 1 308.5) vs.(1 162.3 ±452.6),P=0.000].According to the independent risk factors of unconditioned logistic bivariate regression model analysis,the levels of sST2,NT-proBNP and the clinical heart function Grade had independent predicting value of AHF (OR value were 1.003,1.001 and 7.46 respectively).We found that the cutoff value of sST2 (1 760 pg/mL) may be an valuable evaluation marker of prognosis,the sensitivity and specificity was 64％ and 92％,and the positive and negtive predictive rate were 89％ and 70％.The accuracy rate was 77％.Combined with NT-proBNP to predict the prognosis of AHF,the result would be more exciting.The area under the ROC curve is 0.889.The endpoint event rate of the patients whose level of sST2 was below 1400pg/mL and NT-proBNP level below 4000pg/mL was 7％,while the data in patients whose level of sST2 is above 1400 pg/mL and NT-proBNP above 4000pg/mL was 95％.Conclusions Early at admission of AHF in elderly patients,sST2 began to elevate markedly related with the extent of heart failure.The result shows that the level of sST2 may be used to evaluate patient.The elevation of sST2 has independent predictive value to the prognosis of AHF.It will be better to predict the prognosis combining ST2 with other biomarkers such as NT-proBNP.