【摘要】 目的 观察心力衰竭患者血清可溶性ST2(sST2)水平变化,分析其与B型脑钠肽(BNP)的相关性,探讨sST2在心力衰竭诊断中的应用价值。方法 选取2013年10月~2015年4月于陕西省人民医院已确诊的心力衰竭住院患者216例,按纽约心脏协会(NYHA)心功能分级标准分为心功能Ⅰ级组62例、心功能Ⅱ级组58例、心功能Ⅲ级组54例和心功能Ⅳ级组42例;并收集胸部X线片、心脏彩超和心功能正常的80例作为对照组。用ELISA法测定血清sST2浓度和用电化学免疫发光法测定血浆BNP水平;采用SPSS18.0统计软件包对数据进行统计学处理。结果 心功能Ⅰ~Ⅳ级组血清sST2均显著高于正常对照组,差异均有统计学意义(P<0.05或P<0.001);心功能Ⅰ~Ⅳ级组之间,心功能Ⅱ级组高于心功能Ⅰ级组(P<0.05),心功能Ⅲ,Ⅳ级组均显著高于心功能Ⅰ,Ⅱ级组(P<0.001),而心功能Ⅳ级组虽然与心功能Ⅲ级组有差异,但无统计学意义(P>0.05)。而心功能Ⅰ~Ⅳ级组血浆BNP水平均显著高于正常对照组(P<0.001),并且随着心功能分级递增而逐渐升高,四组之间比较差异均有统计学意义(均P<0.001)。相关性分析,sST2与BNP呈正相关(r=0.453,P<0.01);根据心力衰竭诊断的ROC曲线下面积:sST2为0.812,灵敏度为83%,特异度为71%;BNP为0.913,灵敏度为88%,特异度为79%;两者联合诊断心力衰竭价值升高,ROC曲线下面积为0.941,灵敏度为92%,特异度为83%。结论 血清sST2与血浆BNP呈正相关,可作为心力衰竭诊断的新的生化指标。sST2联合BNP检测可提高对心力衰竭的诊断价值。更多还原

【Abstract】 Objective To observe serum soluble ST2(sST2) level of patients with heart failure,analyze its correlation with type B brain natriuretic peptide(BNP),and explore the application value of sST2 in diagnosis of heart failure.Methods Selected 216 cases of hospitalized patients with heart failure in Shaanxi Provincial People’s Hospital from April 2013 to October 2015.According to the classification standard of New York Heart Association(NYHA) for cardiac function,they were divided into cardiac function Ⅰ grade group(62 cases),Ⅱ(58 cases),Ⅲ(54 cases) and Ⅳ(42 cases),and to collect chest X-ray,echocardiography and cardiac function in normal 80 cases as control group.The serum sST2 concentrations were determined by ELISA,the plasma BNP levels were determined by electrochemical immunoassay,and the data were statistically analyzed by SPSS18.0 statistics software.Results Serum sST2 of cardiac function Ⅰ to Ⅳ group were significantly higher than that in the normal control group(P<0.05 or P<0.001).Between the cardiac function Ⅰ~Ⅳ group,serum sST2 ofⅡ group was higher than that of I group(P<0.05),serum sst2 of IQ and IV group were significantly higher than those ofⅠ and Ⅱ group(P<0.001).Although cardiac function Ⅲ grade group was different from the functional Ⅳ grade,but no statistical significance(P>0.05).Cardiac function Ⅰ to Ⅳ group,the plasma BNP levels were significantly higher than those of normal control group(P<0.001),and with the cardiac function grading increasing,the plasma BNP levels gradually increased.Compared the four groups,differences were statistically significant(P<0.001).Correlation analysis,sST2 and BNP were positively correlated(r= 0.453,P<0.01).According to the area under the ROC curve for the diagnosis of heart failure:sST2 was 0.812,sensitivity was 83%and specificity was 71%;BNP was 0.913,sensitivity was 88%,and specificity was 79%.Both combined diagnosis,the value of heart failure increased,area of under the ROC curve was 0.941.sensitivity was 92%and specificity was 83%.Conclusion Serum sST2 and BNP were positively correlated,and they could be used as the new biochemical index for the diagnosis of heart failure,combined detection of sST2 and BNP can improve the diagnostic value of heart failure.更多还原