心衰患者血清sST2水平与心功能及左室重构的关系
发布时间：2019-06-19 06:41
【摘要】：目的探讨心衰患者血清sST2水平变化对于心衰严重程度危险分层及心功能的评估价值;探讨心衰患者血清sST2水平与左心室重构程度的关系;探讨sST2对心衰预后的评估价值。方法入组2014年1月到2015年6月天津市人民医院心内科收治的存在心力衰竭危险因素的处于A/B期及临床诊断为心力衰竭符合C/D期标准的患者共195例为研究对象,心力衰竭的诊断标准参考2014中国心力衰竭诊断和治疗指南;入组同期我院查体中心老年健康人群30例为对照组。检测入组患者空腹12h后血sST2、NT-proBNP、hs-CRP及其他生化指标水平;完善彩色多普勒超声心动图检查,测量LAD、LVEDD、IVST、LVPWT、LVEF等指标;随访心衰患者因心衰加重再入院或心血管死亡事件发生情况;分成不同亚组进行统计学分析。结果(1)心衰组患者血清sST2水平高于对照组,且随着心功能分级的增高而增加,心功能III级、IV级组高于对照组及心功能I、II级组,心功能IV级组高于心功能III级组,差异有统计学意义(P0.05)。(2)sST2水平随着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,差异有统计学意义(P0.05)。(3)sST2水平随着LVEF水平的降低而升高,各组间差异有统计学意义(P0.05)。(4)不同eGFR分组间、心衰是否合并高血压分组间及心衰是否合并心房颤动分组间比较,血清sST2水平差异无统计学意义。(5)sST2对于判定心血管终点事件发生情况的ROC曲线下面积为0.686(95%可信区间:0.585-0.787,P0.01),NT-proBNP的ROC曲线下面积为0.697(95%可信区间:0.604-0.791,P0.01);ST2判定心血管终点事件发生情况的最佳cut-off值为118.80ng/ml,NT-proBNP的最佳cut-off值2381.50ng/ml。(6)不同sST2水平下比较,高sST2水平组事件发生率、SHFM预期寿命、LVEDD均高于低sST2水平组,差异有统计学意义(P0.05)。(7)发生心血管终点事件组血清sST2、NT-proBNP、LVEDD水平均高于未发生终点事件组,而LVEF、SHFM预期寿命水平均低于未发生终点事件组,差异有统计学意义(P0.05)。(8)sST2分别与NT-proBNP、TnT、hs-CRP、LVEDD呈正相关,与LVEF呈负相关;SHFM预期寿命分别与sST2、NT-proBNP、LVEDD呈负相关,与LVEF呈正相关。(9)生存分析发现,高sST2水平组生存率低于低sST2水平组,差异有统计学意义(P0.05);COX比例风险回归模型发现,高sST2水平组发生终点事件的危险度是低sST2水平组的3.37倍,高NT-proBNP组发生心终点事件的危险度是低NT-proBNP组的1.92倍。结论(1)心衰患者血清sST2水平随NYHA心功能分级的增加而增加,随LVEF的降低而增加,与NT-proBNP呈正相关,与LVEF呈负相关,sST2升高程度可以与NT-proBNP协同评估心衰患者的心功能情况。(2)血清sST2在心衰B期(即发生心室重构时)增高,而NT-proBNP在心衰C期才有升高,故血清sST2可在心衰出现临床症状前发现潜在的心衰患者,且其水平与LVEDD等指标有相关性,可以反映早期心室重构的程度。(3)高血清sST2水平组其发生终点事件的概率高于低水平组,与SHFM预期寿命呈负相关,且其对于发生心衰终点事件的危险系数高于NT-proBNP,血清sST2水平对于心衰预后的评估价值高于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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.6
本文编号：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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.6
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