可溶性人基质裂解素对急性失代偿心力衰竭伴肾功能不全病人预后的预测价值

目的 探讨可溶性人基质裂解素(sST2)对急性失代偿心力衰竭(ADHF)伴肾功能不全病人预后的预测价值.方法 选取住院的ADHF病人94例.检测N-末端脑钠肽前体(NT-proBNP)、sST2水平.根据估算肾小球滤过率(eGFR),将病人分为两组,A组(eGFR<60 mL·min-1·1.73 m-2)42例,B组(eGFR≥60 mL·min-1·1.73 m-2)52例.随访时间为6个月,记录出院后发生因心衰再入院及全因性死亡事件.根据受试者特征(ROC)曲线得到sST2、NT-proBNP预测ADHF病人短期预后的ROC曲线下面积(AUC)及最佳截断值、灵敏度、特异度,分别比较两者在两组中的AUC.结果 sST2与lg(NT-proBNP)呈正相关(r=0.579,P<0.01).sST2水平在两组中差异无统计学意义(P>0.05).随访6个月后,A组因心衰再入院及全因死亡发生率高于B组(P=0.034).A组中sST2、NT-proBNP预测病人因心衰再入院及全因死亡AUC分别为0.793(95%CI:0.654~0.932,P=0.002)、0.745(95%CI:0.594~0.896,P=0.008).结论 sST2不受肾功能影响,并且对ADHF伴肾功能不全病人发生因心衰再入院及全因死亡的短期预后有较好预测价值.

Prognostic value of soluble ST2 in treating patients with acute decompensated heart failure and renal insufficiency

Objective To explore the predictive value of soluble ST2 (sST2) on the prognosis of acute decompensated heart failure (ADHF) and renal insufficiency.Methods Ninety-four cases of ADHF were selected.The level of sST2 and NT-proBNP were detected.According to the estimated glomerular filtration rate (eGFR),the patients were assigned into 2 groups.There were 42 cases as group A (eGFR<60 mL·min-1·1.73 m-2),and 52 cases as group B (eGFR≥60 mL·min-1·1.73 m-2).The follow-up time was 6 months.The events of the occurrence of all-cause death and readmission due to heart failure were observed.According to the receiver operator characteristic (ROC) curve,the area under the ROC curve (AUC) and the optima-1 cut-off value,sensitivity and specificity of sST2 and NT-proBNP were caculated to predict the shortterm prognosis of ADHF patients.The AUC of sST2 and NT-proBNP in the two groups were compared.Results There were positive correlations between sST2 and lg (NT-proBNP)(r=0.579,P<0.01).There was no significant difference in sST2 level between the two groups(P>0.05).After 6 months of follow-up,readmission of group A due to heart failure and all-cause mortality rate was higher than group B (P=0.034).In group A,the AUC of sST2 and NT-proBNP predicting readmission due to heart failure and all cause mortality were 0.793 (95%CI:0.654-0.932,P=0.002),and 0.745(95%CI:0.594-0.896,P=0.008),respectively.Conclusions sST2 has better short-term predictive value in heart failure readmission and all-cause death of acute decompensated heart failure patients with renal insufficiency,and it is not affected by renal function compared with NT-proBNP in ADHF patients.