【摘要】 目的:回顾性分析可溶性生长刺激表达基因2(sST2)蛋白血清水平与维持性血透合并心力衰竭(HF)患者短期预后的相关性。方法:选取2016-01—2017-12在本院血透中心行维持性血透且病历资料完整患者作为观察组(n=86),并按HF患者左室射血分数(LVEF)不同分为LVEF降低HF组(HFrEF组,n=22)、LVEF中间范围HF组(HFmrEF组,n=26)和LVEF保留HF组(HFpEF组,n=38),另选同期年龄和性别匹配的体检健康者作为对照组(n=20)。采用ELISA检测各组血清sST2、氨基末端脑钠肽前体(NT pro-BNP)水平,收集病历资料中性别、年龄、血压、血脂、血红蛋白、血浆白蛋白、血肌酐、心肌肌钙蛋白(TNI)、脑钠肽(BNP)、LVEF、左室舒张末内径等数据,比较观察组与对照组,以及观察组中不同类型HF组有关指标的分布差异。并对观察组随访1年后,以患者是否出现HF再入院或因心血管事件死亡等终点事件分为事件组(n=28)和非事件组(n=58)。分析sST2等因素与患者终点事件发生的相关性及独立预测意义。结果:与对照组相比,观察组sST2、NT pro-BNP及BNP均明显升高(P<0.01),不同心衰组血浆白蛋白、sST2、BNP、LVEF、左室舒张末期内径和TNI水平差异有统计学意义(P<0.05或P<0.01);单因素Spearman相关性分析表明年龄越大, sST2、BNP水平越高,患者终点事件的发生越多,呈明显正相关(P<0.05或P<0.01),而LVEF越高,终点事件发生越少,两者呈明显负相关(P<0.01);Logistic回归分析显示LVEF、sST2对血透患者1年内因HF再次入院或因心血管事件死亡有独立预测意义(P<0.05或P<0.01)。结论:sST2与其它心衰标志物类似,与维持性血透合并HF患者终点事件的发生存在相关性,而且与LVEF一起对患者终点事件具有预测价值。更多还原

【Abstract】 Objective: To retrospectively analyze the correlation between the serum level of soluble growth stimulating express gene 2(sST2) and the short-term prognosis in maintenance hemodialysis patients combined with heart failure.Method: Maintenance hemodialysis patients in our hemodialysis center with intact medical records(n=86) were enrolled from January 2016 to December 2017. According to the left ventricular ejection fraction(LVEF), hemodialysis patients were divided into heart failure with reduced ejection fraction group(HFrEF group, n=22), heart failure with mid-range ejection fraction group(HFmrEF group, n=26), and heart failure with preserved ejection fraction group(HFpEF group, n=38). Meanwhile, healthy person with age and gender matched were selected as a control group(n=20). The levels of serum sST2, N-terminal pro-B-type natriuretic peptide(NT pro-BNP) and brain natriuretic peptide(BNP) were measured by ELISA. The records of gender, age, blood pressure, blood lipid,hemoglobin,plasma albumin,serum creatinine,troponin I(TNI),LVEF,Left ventricular end diastolic diameter(LVEDD)were collected and analyzed in observation groups and control group.According to re-hospitalization or death for cardiovascular causes in one-year follow-up,the maintenance hemodialysis patients with heart failure were divided into endpoint event group(n=28)and non-endpoint event group(n=58).The correlation between clinical parameters and the occurrence of end-point events in hemodialysis patients were analyzed by Univariate Spearman correlation analysis.Logistic regression analysis was performed to identify independent predictive factors for cardiac end-point events.Results:Compared with the control group,the serum levels of sST2,NT pro-BNP and BNP were significantly increased in the observation group(P<0.01).The differences of plasma albumin,LVEF,LVEDD,TNI,sST2 and BNP levels in observation groups were statistically significant(P<0.05 or P<0.01);Univariate Spearman correlation analysis showed that age,sST2 and BNP levels were positively correlated with occurrence of cardiac end-point events(P<0.05 or P<0.01),but negatively correlated with LVEF(P<0.01).Logistic regression analysis showed that LVEF and sST2 had independent predictive value for appearance of cardiac end-point events in hemodialysis patients with heart failure(P<0.05 or P<0.01).Conclusion:sST2 is associated with the cardiac death or re-hospitalization in maintenance hemodialysis patients,which has predictive value for cardiac endpoint events with LVEF.更多还原