心衰患者血清sST2水平與心功能及左室重構(gòu)的關(guān)系
發(fā)布時間：2019-06-19 06:41
【摘要】：目的探討心衰患者血清sST2水平變化對于心衰嚴重程度危險分層及心功能的評估價值;探討心衰患者血清sST2水平與左心室重構(gòu)程度的關(guān)系;探討sST2對心衰預(yù)后的評估價值。方法入組2014年1月到2015年6月天津市人民醫(yī)院心內(nèi)科收治的存在心力衰竭危險因素的處于A/B期及臨床診斷為心力衰竭符合C/D期標(biāo)準(zhǔn)的患者共195例為研究對象,心力衰竭的診斷標(biāo)準(zhǔn)參考2014中國心力衰竭診斷和治療指南;入組同期我院查體中心老年健康人群30例為對照組。檢測入組患者空腹12h后血sST2、NT-proBNP、hs-CRP及其他生化指標(biāo)水平;完善彩色多普勒超聲心動圖檢查,測量LAD、LVEDD、IVST、LVPWT、LVEF等指標(biāo);隨訪心衰患者因心衰加重再入院或心血管死亡事件發(fā)生情況;分成不同亞組進行統(tǒng)計學(xué)分析。結(jié)果(1)心衰組患者血清sST2水平高于對照組,且隨著心功能分級的增高而增加,心功能III級、IV級組高于對照組及心功能I、II級組,心功能IV級組高于心功能III級組,差異有統(tǒng)計學(xué)意義(P0.05)。(2)sST2水平隨著心衰分期的增加而增高,心衰B、C、D期均高于心衰A期,心衰D期高于心衰B、C期,差異有統(tǒng)計學(xué)意義(P0.05)。(3)sST2水平隨著LVEF水平的降低而升高,各組間差異有統(tǒng)計學(xué)意義(P0.05)。(4)不同eGFR分組間、心衰是否合并高血壓分組間及心衰是否合并心房顫動分組間比較,血清sST2水平差異無統(tǒng)計學(xué)意義。(5)sST2對于判定心血管終點事件發(fā)生情況的ROC曲線下面積為0.686(95%可信區(qū)間:0.585-0.787,P0.01),NT-proBNP的ROC曲線下面積為0.697(95%可信區(qū)間:0.604-0.791,P0.01);ST2判定心血管終點事件發(fā)生情況的最佳cut-off值為118.80ng/ml,NT-proBNP的最佳cut-off值2381.50ng/ml。(6)不同sST2水平下比較,高sST2水平組事件發(fā)生率、SHFM預(yù)期壽命、LVEDD均高于低sST2水平組,差異有統(tǒng)計學(xué)意義(P0.05)。(7)發(fā)生心血管終點事件組血清sST2、NT-proBNP、LVEDD水平均高于未發(fā)生終點事件組,而LVEF、SHFM預(yù)期壽命水平均低于未發(fā)生終點事件組,差異有統(tǒng)計學(xué)意義(P0.05)。(8)sST2分別與NT-proBNP、TnT、hs-CRP、LVEDD呈正相關(guān),與LVEF呈負相關(guān);SHFM預(yù)期壽命分別與sST2、NT-proBNP、LVEDD呈負相關(guān),與LVEF呈正相關(guān)。(9)生存分析發(fā)現(xiàn),高sST2水平組生存率低于低sST2水平組,差異有統(tǒng)計學(xué)意義(P0.05);COX比例風(fēng)險回歸模型發(fā)現(xiàn),高sST2水平組發(fā)生終點事件的危險度是低sST2水平組的3.37倍,高NT-proBNP組發(fā)生心終點事件的危險度是低NT-proBNP組的1.92倍。結(jié)論(1)心衰患者血清sST2水平隨NYHA心功能分級的增加而增加,隨LVEF的降低而增加,與NT-proBNP呈正相關(guān),與LVEF呈負相關(guān),sST2升高程度可以與NT-proBNP協(xié)同評估心衰患者的心功能情況。(2)血清sST2在心衰B期(即發(fā)生心室重構(gòu)時)增高,而NT-proBNP在心衰C期才有升高,故血清sST2可在心衰出現(xiàn)臨床癥狀前發(fā)現(xiàn)潛在的心衰患者,且其水平與LVEDD等指標(biāo)有相關(guān)性,可以反映早期心室重構(gòu)的程度。(3)高血清sST2水平組其發(fā)生終點事件的概率高于低水平組,與SHFM預(yù)期壽命呈負相關(guān),且其對于發(fā)生心衰終點事件的危險系數(shù)高于NT-proBNP,血清sST2水平對于心衰預(yù)后的評估價值高于NT-proBNP。
[Abstract]:Objective To study the value of sST2 in patients with heart failure and to evaluate the value of sST2 in patients with heart failure, and to explore the relationship between sST2 level and the degree of left ventricular remodeling in patients with heart failure, and to explore the value of sST2 in the evaluation of the prognosis of heart failure. Methods A total of 195 patients with heart failure risk factors were enrolled in the department of Cardiology of Tianjin People's Hospital from January 2014 to June 2015. The criteria for the diagnosis of heart failure are referred to in the guidelines for the diagnosis and treatment of heart failure in 2014; in the same period,30 cases of the elderly healthy population in our hospital were compared with the control group. The levels of sST2, NT-proBNP, hs-CRP and other biochemical markers were measured after fasting for 12 h, and the indexes of LAD, LVEDD, IVST, LVPWT and LVEF were measured by color Doppler echocardiography. Statistical analysis was performed in different subgroups. Results (1) The serum sST2 level in the heart failure group was higher than that of the control group, and the heart function grade III and IV group were higher than that in the control group and the heart function group I and II group with the increase of the heart function grade, and the difference of the heart function group IV group was higher than that of the heart function group III group (P0.05). (2) The level of sST2 increased with the increase of the stage of heart failure, and the levels of heart failure B, C and D were higher than that in the A phase of the heart failure, and the D phase of the heart failure was higher than that in the B and C phases of the heart failure (P0.05). (3) sST2 level increased with the decrease of the level of LVEF, and there was a significant difference between the groups (P0.05). (4) The level of sST2 in serum sST2 was not statistically significant between groups of eGFR, whether heart failure was combined with hypertension and whether heart failure was combined with atrial fibrillation. (5) sST2, under the ROC curve for determining the occurrence of cardiovascular end events, the area was 0.686 (95% confidence interval: 0.585-0.787, P0.01), and the area under the ROC curve of NT-proBNP was 0.697 (95% confidence interval: 0.604-0.791, P0.01); ST2 was the best cut-off value of 118.80 ng/ ml, and the best cut-off value of NT-proBNP was 2381.50 ng/ ml. (6) The incidence of events in the high sST2 level group, the expected life of the SHFM and the LVEDD were higher than that of the low sST2 level group at different sST2 levels (P0.05). (7) The levels of sST2, NT-proBNP and LVEDD in serum sST2, NT-proBNP and LVEDD in the event of cardiovascular end events were higher than that of the non-end-end event group, while the expected life level of LVEF and SHFM was lower than that of the non-end-end event group (P0.05). (8) sST2 was positively correlated with NT-proBNP, TnT, hs-CRP and LVEDD, and negatively correlated with LVEF; the expected life of SHFM was negatively correlated with sST2, NT-proBNP and LVEDD, and was positively correlated with LVEF. (9) The survival analysis found that the survival rate of the high sST2 level group was lower than that of the low sST2 level group, and the difference was significant (P0.05); the COX proportional risk regression model found that the risk of the end event in the high sST2 horizontal group was 3.37 times that of the low sST2 horizontal group, The risk of cardiac endpoint events in the high NT-proBNP group was 1.92 times that of the low NT-proBNP group. Conclusion (1) The level of sST2 in patients with heart failure increases with the increase of NYHA functional classification, which increases with the decrease of LVEF, is positively related to NT-proBNP and negatively related to LVEF, and the level of sST2 increases with NT-proBNP to assess the cardiac function of patients with heart failure. (2) Serum sST2 increased in the B-phase of heart failure (i.e., in the case of ventricular remodeling), and NT-proBNP increased in the C-phase of heart failure, so the serum sST2 can be found in the patients with potential heart failure before the clinical symptoms of heart failure, and the level of the serum sST2 is related to the LVEDD and other indexes, which can reflect the degree of early ventricular remodeling. (3) The probability of an end event in the high serum sST2 level group was higher than that of the low-level group, negatively correlated with the expected life of the SHFM, and the risk factor for the event of heart failure endpoint was higher than that of NT-proBNP, and the value of sST2 in serum sST2 was higher than that of NT-proBNP.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R541.6
本文編號：2502174
[Abstract]:Objective To study the value of sST2 in patients with heart failure and to evaluate the value of sST2 in patients with heart failure, and to explore the relationship between sST2 level and the degree of left ventricular remodeling in patients with heart failure, and to explore the value of sST2 in the evaluation of the prognosis of heart failure. Methods A total of 195 patients with heart failure risk factors were enrolled in the department of Cardiology of Tianjin People's Hospital from January 2014 to June 2015. The criteria for the diagnosis of heart failure are referred to in the guidelines for the diagnosis and treatment of heart failure in 2014; in the same period,30 cases of the elderly healthy population in our hospital were compared with the control group. The levels of sST2, NT-proBNP, hs-CRP and other biochemical markers were measured after fasting for 12 h, and the indexes of LAD, LVEDD, IVST, LVPWT and LVEF were measured by color Doppler echocardiography. Statistical analysis was performed in different subgroups. Results (1) The serum sST2 level in the heart failure group was higher than that of the control group, and the heart function grade III and IV group were higher than that in the control group and the heart function group I and II group with the increase of the heart function grade, and the difference of the heart function group IV group was higher than that of the heart function group III group (P0.05). (2) The level of sST2 increased with the increase of the stage of heart failure, and the levels of heart failure B, C and D were higher than that in the A phase of the heart failure, and the D phase of the heart failure was higher than that in the B and C phases of the heart failure (P0.05). (3) sST2 level increased with the decrease of the level of LVEF, and there was a significant difference between the groups (P0.05). (4) The level of sST2 in serum sST2 was not statistically significant between groups of eGFR, whether heart failure was combined with hypertension and whether heart failure was combined with atrial fibrillation. (5) sST2, under the ROC curve for determining the occurrence of cardiovascular end events, the area was 0.686 (95% confidence interval: 0.585-0.787, P0.01), and the area under the ROC curve of NT-proBNP was 0.697 (95% confidence interval: 0.604-0.791, P0.01); ST2 was the best cut-off value of 118.80 ng/ ml, and the best cut-off value of NT-proBNP was 2381.50 ng/ ml. (6) The incidence of events in the high sST2 level group, the expected life of the SHFM and the LVEDD were higher than that of the low sST2 level group at different sST2 levels (P0.05). (7) The levels of sST2, NT-proBNP and LVEDD in serum sST2, NT-proBNP and LVEDD in the event of cardiovascular end events were higher than that of the non-end-end event group, while the expected life level of LVEF and SHFM was lower than that of the non-end-end event group (P0.05). (8) sST2 was positively correlated with NT-proBNP, TnT, hs-CRP and LVEDD, and negatively correlated with LVEF; the expected life of SHFM was negatively correlated with sST2, NT-proBNP and LVEDD, and was positively correlated with LVEF. (9) The survival analysis found that the survival rate of the high sST2 level group was lower than that of the low sST2 level group, and the difference was significant (P0.05); the COX proportional risk regression model found that the risk of the end event in the high sST2 horizontal group was 3.37 times that of the low sST2 horizontal group, The risk of cardiac endpoint events in the high NT-proBNP group was 1.92 times that of the low NT-proBNP group. Conclusion (1) The level of sST2 in patients with heart failure increases with the increase of NYHA functional classification, which increases with the decrease of LVEF, is positively related to NT-proBNP and negatively related to LVEF, and the level of sST2 increases with NT-proBNP to assess the cardiac function of patients with heart failure. (2) Serum sST2 increased in the B-phase of heart failure (i.e., in the case of ventricular remodeling), and NT-proBNP increased in the C-phase of heart failure, so the serum sST2 can be found in the patients with potential heart failure before the clinical symptoms of heart failure, and the level of the serum sST2 is related to the LVEDD and other indexes, which can reflect the degree of early ventricular remodeling. (3) The probability of an end event in the high serum sST2 level group was higher than that of the low-level group, negatively correlated with the expected life of the SHFM, and the risk factor for the event of heart failure endpoint was higher than that of NT-proBNP, and the value of sST2 in serum sST2 was higher than that of NT-proBNP.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R541.6
【參考文獻】
相關(guān)期刊論文 前3條
1 張榮成;張宇輝;張健;黃燕;郭瀟;王運紅;安濤;周瓊;呂榮;季詩明;;可溶性ST2對心力衰竭患者死亡的預(yù)測價值[J];中華心血管病雜志;2014年09期
2 汪芳;黃潔;龐會敏;邊文彥;王莉;明廣華;頊志敏;李一石;;慢性心力衰竭患者血漿氨基末端腦鈉素前體水平對病情的評估[J];臨床心血管病雜志;2006年07期
3 ;NT-proBNP臨床應(yīng)用中國專家共識[J];中國心血管病研究雜志;2011年06期
，本文編號：2502174
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