CAJ | 학술논문

目的观察住院心力衰竭(心衰)患者血浆可溶性ST2(sST2)水平与其他指标的相关性,探讨其对心衰患者死亡的预测价值.方法入选2009年3月至2012年7月阜外心血管病医院心力衰竭中心以心衰为主要原因住院的患者1 244例.采用酶联免疫吸附法测定患者入院时血浆sST2水平.随访1年,终点事件为全因死亡.结果 1 244例心衰患者死亡193例.患者入院时血浆sST2水平与N末端B型利钠肽原(NT-proBNP)、纽约心脏病协会(NYHA)心功能分级以及心率呈正相关,与左心室射血分数(LVEF)、收缩压、血钠、总胆固醇、肾小球滤过率呈负相关.1年内死亡患者血浆sST2水平明显高于未死亡者(P＜0.01).多因素Cox回归模型分析显示,患者基线sST2水平与死亡明显相关,LnsST2每变化1个单位风险增加1.87倍.sST2对预后判断的ROC曲线下面积(AUC=0.776)与NT-proBNP(AUC=0.775)近似,将二者联合应用预测效果(AUC =0.813)明显提高.结论住院心衰患者基线sST2水平与临床及生化变量相关.sST2可以独立预测心衰患者的全因死亡,且与NT-proBNP联合应用可增加预测能力.
목적 관찰주원심력쇠갈(심쇠)환자혈장가용성ST2(sST2)수평여기타지표적상관성,탐토기대심쇠환자사망적예측개치.방법 입선2009년3월지2012년7월부외심혈관병의원심력쇠갈중심이심쇠위주요원인주원적환자1 244례.채용매련면역흡부법측정환자입원시혈장sST2수평.수방1년,종점사건위전인사망.결과 1 244례심쇠환자사망193례.환자입원시혈장sST2수평여N말단B형리납태원(NT-proBNP)、뉴약심장병협회(NYHA)심공능분급이급심솔정정상관,여좌심실사혈분수(LVEF)、수축압、혈납、총담고순、신소구려과솔정부상관.1년내사망환자혈장sST2수평명현고우미사망자(P＜0.01).다인소Cox회귀모형분석현시,환자기선sST2수평여사망명현상관,LnsST2매변화1개단위풍험증가1.87배.sST2대예후판단적ROC곡선하면적(AUC=0.776)여NT-proBNP(AUC=0.775)근사,장이자연합응용예측효과(AUC =0.813)명현제고.결론 주원심쇠환자기선sST2수평여림상급생화변량상관.sST2가이독립예측심쇠환자적전인사망,차여NT-proBNP연합응용가증가예측능력.
Objective To explore the predict value of plasma soluble ST2 (sST2) on one-year mortality for hospitalized patients with chronic heart failure (HF).Methods A total of 1 244 consecutive hospitalized patients admitted to Heart Failure Center Fuwai Hospital between March 2009 and July 2012 and with HF as their primary diagnosis were included.Plasma sST2 was measured in all patients and patients were followed up for 1 year,and the primary endpoint was defined as all-cause death.Results There were 193 deaths during follow up.sST2 concentrations at admission were positively correlated with NT-proBNP,NYHA functional class and heart rate,and negatively correlated with left ventricular ejection fraction,blood sodium,total cholesterol and glomerular filtration rate at admission.sST2 concentrations were significantly higher in non-survivors compared with survivors (P ＜0.001).Multivariable Cox regression analyses showed that sST2 independently predicted 1-year mortality (per 1 log unit,hazard ratio 1.87,95％ confidence interval:1.56 to 2.25,P ＜0.001).In receiver operating characteristic analyses,the area under the curve for ST2 was 0.776 which was similar to that of N-terminal pro-B-type natriuretic peptide (NT-proBNP)(AUC =0.775).The prognostic value was improved when combining these two biomarkers together (AUC =0.813).Conclusions sST2 concentration at admission is correlated with clinical and biochemical indexes and associated with 1-year mortality for hospitalized patients with HF.