扩张型心肌病患者血清可溶性ST2与心室重构的相关性研究
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摘要
目的探讨扩张型心肌病(DCM)患者血清可溶性ST2(s ST2)与心室重构的相关性。方法选取2012年1月—2016年12月收治的94例DCM患者作为观察组,选择同期体检正常者60例作为对照组,记录2组性别、年龄等临床资料,检测s ST2、基质金属蛋白酶14(MMP-14)、C-反应蛋白(CRP)、脑钠肽(BNP),并行心脏超声检查,分析2组相关临床指标与心脏超声相关指标间的相关性。结果观察组s ST2、MMP-14、CRP和BNP水平高于对照组,左心室舒张末期内径(LVDd)、左心房内径(LAD)和右心室内径(RVD)值均较对照组增大,而左心室射血分数(LVEF)和左心室短轴缩短率(LVFS)值均较对照组降低(P<0.05)。s ST2、MMP-14、CRP和BNP与LVDd呈正相关,与LVEF呈负相关(P<0.01)。结论 DCM患者s ST2水平升高,且与LVDd呈正相关,与LVEF呈负相关,可进一步促进DCM患者心室重构而增加心力衰竭发生风险。
Objective To investigate correlation between serum soluble ST2( s ST2) and ventricular remodeling in patients with dilated cardiomyopathy( DCM). Methods A total of 94 DCM patients( observation group) and 60 normal people taking medical examination( control group) admitted during January 2012 and December 2016 were recruited in this study. Clinical informations such as sex and age were recorded,and s ST2,matrix metalloproteinase-14( MMP-14),c-reaction protein( CRP) and brain natriuretic peptide( BNP) were detected,and then ultrasonography was performed in two groups. Correlations between clinical indexes and echocardiographic parameters were analyzed in two groups. Results Compared with those in control group,in observation group,s ST2,MMP-14,CRP and BNP levels were significantly higher,and values of left ventricular end diastolic dimension( LVDd),left atrial dimension( LAD)and right atrial dimension( RVD) were significantly higher,while values of left ventricular ejection fraction( LVEF) and left ventricular fractional shortening( LVFS) were significantly lower( P < 0. 01). The s ST2,MMP-14,CRP and BNP had a positive correlation with LVDd and negative correlation with LVEF( P < 0. 05). Conclusion The s ST2 level in DCM patients shows increasing and positively correlated with LVDd and negatively correlated with LVEF,and it may further promote ventricular remodeling and increase possibility of heart failure in patients with DCM.
Objective To investigate correlation between serum soluble ST2( s ST2) and ventricular remodeling in patients with dilated cardiomyopathy( DCM). Methods A total of 94 DCM patients( observation group) and 60 normal people taking medical examination( control group) admitted during January 2012 and December 2016 were recruited in this study. Clinical informations such as sex and age were recorded,and s ST2,matrix metalloproteinase-14( MMP-14),c-reaction protein( CRP) and brain natriuretic peptide( BNP) were detected,and then ultrasonography was performed in two groups. Correlations between clinical indexes and echocardiographic parameters were analyzed in two groups. Results Compared with those in control group,in observation group,s ST2,MMP-14,CRP and BNP levels were significantly higher,and values of left ventricular end diastolic dimension( LVDd),left atrial dimension( LAD)and right atrial dimension( RVD) were significantly higher,while values of left ventricular ejection fraction( LVEF) and left ventricular fractional shortening( LVFS) were significantly lower( P < 0. 01). The s ST2,MMP-14,CRP and BNP had a positive correlation with LVDd and negative correlation with LVEF( P < 0. 05). Conclusion The s ST2 level in DCM patients shows increasing and positively correlated with LVDd and negatively correlated with LVEF,and it may further promote ventricular remodeling and increase possibility of heart failure in patients with DCM.
引文
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[10]侯磊.多巴酚丁胺联合参附注射液治疗扩张型心肌病心力衰竭的效果观察[J].保健医学研究与实践,2017,14(2):70-72.DOI:10.11986/j.issn.1673-873X.2017.02.020.
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[14]王好,陶艾彬,张国辉,等.外源性IL-33在体外模拟糖尿病条件下抑制心肌成纤维细胞胶原蛋白的表达[J].江苏大学学报:医学版,2016,26(5):380-383.DOI:10.13312/j.issn.1671-7783.y160171.
[15]傅庆华,郑昭芬.芪苈强心胶囊对扩张型心肌病伴轻、中度心力衰竭患者心功能和心室重构的影响[J].医学临床研究,2016,33(3):584-586.DOI:10.3969/j.issn.1671-7171.2016.03.057.
[16]王丽娟,白宏兴.多重阻滞剂联用对扩张型心肌病心力衰竭患者心室重构及QT离散度的影响[J].中国循证心血管医学杂志,2015(5):644-646.DOI:10.3969/j.issn.1674-4055.2015.05.18.
[17]徐琳萍.影响扩张型心肌病心力衰竭后射血分数的危险因素分析[J].现代仪器与医疗,2016,22(22):65-67.
[18]韩冰,李妮,聂荷香,等.心力衰竭患者血清中可溶性ST2和脑钠肽相关性分析[J].标记免疫分析与临床,2015,22(1):4-6.
[19]童敏,董佳敏,刘静,等.扩张型心肌病患者血清半乳糖凝集素-3水平变化及其与胶原代谢标志物的相关性分析[J].疑难病杂志,2016,15(9):908-911.DOI:10.3969/j.issn.1671-6450.2016.09.008.
[20]文安明,杨永曜.不同阻滞剂组合对扩张型心肌病心室重构及QT离散度的影响比较[J].贵州医药,2016,40(9):913-915.DOI:10.3969/j.issn.1000-744X.2016.09.006.
[21]陈枫,李玉英,黄云剑,等.芪苈强心胶囊改善维持性血液透析患者尿毒症性心肌病的临床观察[J].解放军医药杂志,2016,28(S1):8-10.
[22]肖冰冰,高东梅,冯海艳,等.扩张型心肌病患者左心室扭转与重构的关系[J/CD].中华医学超声杂志:电子版,2016,13(6):430-432.DOI:10.3877/cma.j.issn.1672-6448.2016.06.006.
[23]Lupón J,Gaggin H K,de Antonio M,et al.Biomarkerassist score for reverse remodeling prediction in heart failure:The ST2-R2 score[J].Int J Cardiol,2015,184:337-343.DOI:10.1016/j.ijcard.2015.02.019.
[24]车娟,赵洪春,李金玲,等.变应性鼻炎患者血清IL-33和可溶性ST-2检测的临床意义[J].现代免疫学,2016,36(1):42-45.
[25]胡振,张新超,张堃,等.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[J].中华急诊医学杂志,2016,25(8):1035-1040.
[26]张健,邹长虹,黄燕,等.新发扩张型心肌病患者药物治疗后左心室逆重构的发生率及预测因素[J].中华心血管病杂志,2016,44(4):315-320.DOI:10.3760/cma.j.issn.0253-3758.2016.04.008.
[27]孙爱梅,刘婷,陈还珍,等.可溶性ST2对冠心病的危险分层价值及其与心功能的关系[J].中国心血管杂志,2017,22(1):19-23.DOI:10.3969/j.issn.1007-5410.2017.01.004.
[28]王秀艳,赵晓辉,王立波,等.慢性心力衰竭患者血清s ST2与和肽素水平变化及相关性分析[J].心血管康复医学杂志,2017,26(1):49-51.DOI:10.3969/j.issn.1008-0074.2017.01.14.4.
[29]郭永军,关永东,陈军.心力衰竭患者血清可溶性ST2受体的变化及意义[J].中国现代医生,2014,52(32):16-18.
[2]唐俊燕,杨国杰,李栋博,等.血清可溶性Sema4D水平与扩张型心肌病心室重构的相关性研究[J].中国循环杂志,2017,32(1):63-66.DOI:10.3969/j.issn.1000-3614.2017.01.015.
[3]陈镇涛,倪星会,胡英.美托洛尔联合螺内酯治疗扩张型心肌病并心力衰竭的临床研究[J].中国医药科学,2016,6(8):59-61,116.
[4]童敏,张强,董佳敏,等.扩张型心肌病患者血清可溶性ST2水平与Ⅰ型胶原代谢标志物相关性研究[J].临床心血管病杂志,2016,32(11):1146-1149.
[5]郑枫,汪健飞,徐莉,等.二维斑点追踪技术联合实时三维超声心动图评价尿毒症心肌病左心室收缩功能及其同步性[J].江苏大学学报:医学版,2016,26(6):532-536.DOI:10.13312/j.issn.1671-7783.y160211.
[6]王伟川.重组人脑利钠肽治疗扩张型心肌病并急性心衰的作用[J].中国现代医生,2013,51(15):63-64,67.
[7]张杰,何飞,郭荣,等.血清可溶性肿瘤坏死因子样弱凋亡诱导因子水平与扩张型心肌病患者左心室重构的关系[J].山东医药,2017,57(17):7-9.DOI:10.3969/j.issn.1002-266X.2017.17.003.
[8]李春来,许贤彬,吴平彬,等.心外膜脂肪组织厚度与扩张型心肌病患者左室重构及左室功能不全的关系分析[J].中国医师进修杂志,2017,40(4):367-369,372.DOI:10.3760/cma.j.issn.1673-4904.2017.04.021.
[9]闫福堂,苏宝凤,詹颉,等.血清可溶性ST2与血BNP在心力衰竭患者中的相关性研究[J].现代检验医学杂志,2015,30(6):78-79,83.DOI:10.3969/j.issn.1671-7414.2015.06.022.
[10]侯磊.多巴酚丁胺联合参附注射液治疗扩张型心肌病心力衰竭的效果观察[J].保健医学研究与实践,2017,14(2):70-72.DOI:10.11986/j.issn.1673-873X.2017.02.020.
[11]刘豪,关玲霞,杨昕远,等.瑞舒伐他汀对扩张型心肌病慢性心力衰竭患者血浆IL-33、ST2水平的影响[J].中国医师杂志,2017,19(2):301-303.DOI:10.3760/cma.j.issn.1008-1372.2017.02.039.
[12]廉静.参附注射液联合磷酸肌酸钠治疗扩张型心肌病心功能不全的疗效观察[J].养生保健指南,2016(36):109.DOI:10.3969/j.issn.1006-6845.2016.36.104.
[13]Tayal U,Buchan R J,Whiffin N,et al.Effects of Truncating Variants in Titin on Cardiac Phenotype and Left Ventricular Remodelling in Dilated Cardiomyopathy[J].Heart,2016,102(Suppl 6):A102-A103.
[14]王好,陶艾彬,张国辉,等.外源性IL-33在体外模拟糖尿病条件下抑制心肌成纤维细胞胶原蛋白的表达[J].江苏大学学报:医学版,2016,26(5):380-383.DOI:10.13312/j.issn.1671-7783.y160171.
[15]傅庆华,郑昭芬.芪苈强心胶囊对扩张型心肌病伴轻、中度心力衰竭患者心功能和心室重构的影响[J].医学临床研究,2016,33(3):584-586.DOI:10.3969/j.issn.1671-7171.2016.03.057.
[16]王丽娟,白宏兴.多重阻滞剂联用对扩张型心肌病心力衰竭患者心室重构及QT离散度的影响[J].中国循证心血管医学杂志,2015(5):644-646.DOI:10.3969/j.issn.1674-4055.2015.05.18.
[17]徐琳萍.影响扩张型心肌病心力衰竭后射血分数的危险因素分析[J].现代仪器与医疗,2016,22(22):65-67.
[18]韩冰,李妮,聂荷香,等.心力衰竭患者血清中可溶性ST2和脑钠肽相关性分析[J].标记免疫分析与临床,2015,22(1):4-6.
[19]童敏,董佳敏,刘静,等.扩张型心肌病患者血清半乳糖凝集素-3水平变化及其与胶原代谢标志物的相关性分析[J].疑难病杂志,2016,15(9):908-911.DOI:10.3969/j.issn.1671-6450.2016.09.008.
[20]文安明,杨永曜.不同阻滞剂组合对扩张型心肌病心室重构及QT离散度的影响比较[J].贵州医药,2016,40(9):913-915.DOI:10.3969/j.issn.1000-744X.2016.09.006.
[21]陈枫,李玉英,黄云剑,等.芪苈强心胶囊改善维持性血液透析患者尿毒症性心肌病的临床观察[J].解放军医药杂志,2016,28(S1):8-10.
[22]肖冰冰,高东梅,冯海艳,等.扩张型心肌病患者左心室扭转与重构的关系[J/CD].中华医学超声杂志:电子版,2016,13(6):430-432.DOI:10.3877/cma.j.issn.1672-6448.2016.06.006.
[23]Lupón J,Gaggin H K,de Antonio M,et al.Biomarkerassist score for reverse remodeling prediction in heart failure:The ST2-R2 score[J].Int J Cardiol,2015,184:337-343.DOI:10.1016/j.ijcard.2015.02.019.
[24]车娟,赵洪春,李金玲,等.变应性鼻炎患者血清IL-33和可溶性ST-2检测的临床意义[J].现代免疫学,2016,36(1):42-45.
[25]胡振,张新超,张堃,等.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[J].中华急诊医学杂志,2016,25(8):1035-1040.
[26]张健,邹长虹,黄燕,等.新发扩张型心肌病患者药物治疗后左心室逆重构的发生率及预测因素[J].中华心血管病杂志,2016,44(4):315-320.DOI:10.3760/cma.j.issn.0253-3758.2016.04.008.
[27]孙爱梅,刘婷,陈还珍,等.可溶性ST2对冠心病的危险分层价值及其与心功能的关系[J].中国心血管杂志,2017,22(1):19-23.DOI:10.3969/j.issn.1007-5410.2017.01.004.
[28]王秀艳,赵晓辉,王立波,等.慢性心力衰竭患者血清s ST2与和肽素水平变化及相关性分析[J].心血管康复医学杂志,2017,26(1):49-51.DOI:10.3969/j.issn.1008-0074.2017.01.14.4.
[29]郭永军,关永东,陈军.心力衰竭患者血清可溶性ST2受体的变化及意义[J].中国现代医生,2014,52(32):16-18.