血清可溶性ST2、NT-pro BNP联合超声心动图与心力衰竭预后的相关性研究
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摘要
目的探讨血清可溶性ST2(sST2)、NT-pro BNP、超声心动图联合应用是否优于单一指标对慢性心力衰竭患者的预后评估。方法选取2017年3月～2017年6月在安徽省立医院确诊为慢性心力衰竭的住院患者71例作为研究对象,采集静脉血测定sST2、NT-pro BNP,完善超声心动图,记录左室舒张末期内径及左室射血分数的数值。对受试患者进行出院后随访,记录6个月及1年内出现心血管死亡或因心衰住院复合终点累积发生率,进行统计学分析。结果血清可溶性ST2诊断1年内再入院心衰患者的ROC曲线下面积为0.755,差异有统计学意义(P=0.028)。NT-proBNP、sST2、LVEF与心脏左室舒张内径四者联合评估的ROC面积为0.966,差异有统计学意义(P<0.001)。结论 NT-proBNP和ST2单独诊断心衰以及NT-proBNP,LVEF,ST2与左室舒张内径的四者联合应用对预测心力衰竭患者的预后均有意义。联合诊断的意义要大于单独诊断。
Objective To investigate whether sST2, NT-pro BNP, and echocardiography are superior to single index in evaluating the prognosis of patients with heart failure.Methods A total of 71 hospitalized patients with chronic heart failure diagnosed in Anhui Provincial Hospital from March 2017 to June 2017 were enrolled.The venous blood was collected for sST2 and NT-pro BNP. Echocardiogram provides LVDD and LVEF values.The patients were followed up after discharge, and the cumulative incidence of cardiovascular death or hospitalaccumulated end points due to heart failure was recorded for 6 months and 1 year. Statistical analysis was performed.Results The area under the ROC curve of patients with re-admitted heart failure within 1 year after diagnosis of serum soluble ST2 was 0.755,the difference was statistically significant(P=0.028). The ROC area of NTproBNP,sST2,LVEF and left ventricular diastolic diameter was 0.966, and the difference was statistically significant(P<0.001).Conclusion NT-proBNP and ST2 alone in the diagnosis of heart failure and NT-proBNP,LVEF,ST2 combined with left ventricular diastolic diameter are useful for predicting the prognosis of patients with heart failure.Joint diagnosis is more important than diagnosis alone.
Objective To investigate whether sST2, NT-pro BNP, and echocardiography are superior to single index in evaluating the prognosis of patients with heart failure.Methods A total of 71 hospitalized patients with chronic heart failure diagnosed in Anhui Provincial Hospital from March 2017 to June 2017 were enrolled.The venous blood was collected for sST2 and NT-pro BNP. Echocardiogram provides LVDD and LVEF values.The patients were followed up after discharge, and the cumulative incidence of cardiovascular death or hospitalaccumulated end points due to heart failure was recorded for 6 months and 1 year. Statistical analysis was performed.Results The area under the ROC curve of patients with re-admitted heart failure within 1 year after diagnosis of serum soluble ST2 was 0.755,the difference was statistically significant(P=0.028). The ROC area of NTproBNP,sST2,LVEF and left ventricular diastolic diameter was 0.966, and the difference was statistically significant(P<0.001).Conclusion NT-proBNP and ST2 alone in the diagnosis of heart failure and NT-proBNP,LVEF,ST2 combined with left ventricular diastolic diameter are useful for predicting the prognosis of patients with heart failure.Joint diagnosis is more important than diagnosis alone.
引文
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[7]Anne Marie Dupuy,Corentin Curinier,et al.Multi-Marker Strategy in Heart Failure:Combination of ST2 and CRP Predicts Poor Outcome[J].PLoS One,2016,11(6):e0157159.
[8]B.Ky,B.French,K.Mccloskey,J.E.Rame,E.Mc Intosh,P.Shahi,D.L.Dries,W.H.Tang,A.H.Wu,J.C.Fang,R.Boxer,N.K.Sweitzer,W.C.Levy,L.R.Goldberg,M.Jessup,T.P.Cappola High-sensitivity ST2 for prediction of adverse outcomes in chronic heart failure Circ HeartFail[J].4(2011),pp.180-187.
[2]Marc P Bonaca;Anastacia Kudinova,Rahul Kakkar;Benjamin S Scirica,Marc S Sabatine,Sabina A Murphy,Eugene Braunwald,Richard T Lee,David A Morrow.ST2 and the Risk of CV Death or Heart Failure in Patients with Non-ST elevation Acute Coronary Syndromes(NSTE-ACS):Observations from MERLIN-TIMI 36[J].Circulation,2010,Vol.122(No.21).
[3]段勇,宋贵波.ST2:新一代心衰管理标志物[J].实用检验医师杂志,2016,8(1):1-4.
[4]Kohli P,Bonaca M P,Kakkar R,et al.Role of ST2 in non-ST-elevation acute coronary syndrome in the MERLIN-TIMI 36trial[J].Clin Chem,2012,58(1):257-266.
[5]Hakan Güne?,Abdullah Zarars?z,?brahim Gül,Handan Güne?.Relation of Levels of Soluble ST2 with Clinic and Prognosis in Heart Failure Patients[J].The American Journal of Cardiology,2017,119(8):e47.
[6]Ravi H.Parikh,Stephen L.Seliger,et al.Soluble ST2 for Prediction of Heart Failure and Cardiovascular Death in an Elderly,CommunityDwelling Population[J].J Am Heart Assoc,2016,5(8):e003188.
[7]Anne Marie Dupuy,Corentin Curinier,et al.Multi-Marker Strategy in Heart Failure:Combination of ST2 and CRP Predicts Poor Outcome[J].PLoS One,2016,11(6):e0157159.
[8]B.Ky,B.French,K.Mccloskey,J.E.Rame,E.Mc Intosh,P.Shahi,D.L.Dries,W.H.Tang,A.H.Wu,J.C.Fang,R.Boxer,N.K.Sweitzer,W.C.Levy,L.R.Goldberg,M.Jessup,T.P.Cappola High-sensitivity ST2 for prediction of adverse outcomes in chronic heart failure Circ HeartFail[J].4(2011),pp.180-187.