宗斌

[摘要] 目的 探討sST2水平对急性心力衰竭（AHF）患者病情严重程度及预后质量的临床价值。 方法 选取2014年6月～2015年12月徐州市中心医院心内科收治的AHF患者162例，并收集58例体检健康人为对照，所有患者随访1年，记录患者终点事件发生率。采用ELISA对患者入院时的外周血内sST2水平进行测定；全自动生化仪检测NT-proBNP、肌钙蛋白I（TNI）水平；采用ROC曲线分析sST2评估AHF预后的价值。 结果 AHF组患者的sST2、NT-proBNP、TNI水平均明显高于正常组体检人员，差异有统计学意义（P < 0.05）；重度AHF组患者的sST2、NT-proBNP、TNI水平均明显高于轻度AHF组患者，差异有统计学意义（P < 0.05）；随访期间，162例AHF患者中有63例患者发生终点事件，发生率为38.89%，发生终点事件组患者的sST2水平明显高于未发生终点事件组患者，差异有统计学意义（P < 0.05）；Logistic多因素回归分析结果显示：sST2、NT-proBNP、心功能分级3个协变量对AHF患者预后有独立预测意义（OR = 4.003、3.741、7.862）；sST2对AHF患者预后判断的ROC曲线下面积（AUC = 0.820）略高于NT-proBNP（AUC = 0.769），差异无统计学意义（P > 0.05），二者联合应用预测效果明显提高（AUC = 0.938）。 结论 外周血内sST2水平可评价AHF患者病情严重程度及预后，如果结合NT-proBNP等相关生物学标志物，sST2可以更好地进行危险分层及预后评估。

[关键词] sST2；急性心力衰竭；临床心功能分级；预后

[中图分类号] R542.5 [文献标识码] A [文章编号] 1673-7210（2017）09（b）-0060-04

Clinical value analysis of peripheral blood sST2 on risk stratification and prognosis in patients with AHF

ZONG Bin

Department of Cardiology， Xuzhou Central Hospital， Jiangsu Province， Xuzhou 221009， China

[Abstract] Objective To discuss the clinical value of peripheral blood sST2 on risk stratification and prognosis in patients with acute heart failure （AHF）. Methods From June 2014 to December 2015， in Xuzhou Central Hospital， 162 AHF patients were selected， 58 healthy persons were chosen as control group. All patients were followed-up 1 year after AHF attack. The incidence of end point was recorded. The sST2 levels were determined by ELISA and the levelsof NT-proBNP and TNI were detected by automatic biochemical analyzer. The value of them on prognosis were analyzed by ROC curve. Results The levels of sST2， NT-proBNP and TNI in AHF patients were significantly higher than healthy people， the differences were statistically significant （P < 0.05）. The levels of sST2， NT-proBNP and TNI in mild AHF patients were significantly higher than severe AHF patients， the differences were statistically significant （P < 0.05）； 63 patients occurred recurrence of heart failure or cardiac death， and the incidence of the end of observation was 38.89%， the sST2 level in AHF patients with the end of observation was significantly higher than AHF patients without the end of observation， the differences were statistically significant （P < 0.05）. The results of Logistic multifactor regression analysis showed thatthe levels of sST2， NT-proBNP and clinical heart function grade had independent predicting value of AHF （OR = 4.003， 3.741， 7.862）. The area under the ROC curve on prognosis of sST2 （AUC = 0.820） was slightly higher than NT-proBNP （AUC = 0.769）， but the difference was not statistically significant （P > 0.05）. The prognosis value combined sST2 with NT-proBNP was significantly increased （AUC = 0.938）. Conclusion The level of peripheral blood sST2 may be used toevaluaterisk stratification and prognosis in patients with AHF. It will be better to evaluatethe prognosis combining sST2 with other biomarkers such as NT-proBNP.endprint

[Key words] sST2； Acute heart failure； Clinical heart function grade； Prognosis

急性心力衰竭（AHF）指心力衰竭症状和体征突然发作或恶化，是心血管疾病死亡的重要原因[1]。目前对于AHF的诊断主要基于临床症状和实验室检查结果，其中，脑利钠肽（BNP）、N-末端脑利钠肽前体（NT-proBNP）、肌钙蛋白T（TNT）、肌钙蛋白I（TNI）等临床生物标志物检测在心力衰竭的诊断中发挥了重要作用[2-4]。近年来有研究发现，sST2在心力衰竭的病理生理方面存在一定作用，是AHF的生物标志物[5]。此外，多项研究显示sST2的预测心力衰竭患者预后情况不受年龄、性别、体重指数（BMI）等的变化影响[6-8]。本研究选取徐州市中心医院（以下简称“我院”）心内科收治的162例AHF患者作为研究对象，旨在探讨sST2水平在评价AHF病情严重程度及预后质量的临床价值。

1 资料与方法……