【作者】 王丽娜；

【导师】 申国璋；

【作者基本信息】 湖南师范大学 ， 内科学（专业学位）， 2020， 硕士

【摘要】 目的:比较慢性心衰及慢性心衰合并2型糖尿病患者血清sST2水平的变化及通过ROC曲线分析的方法,探讨sST2在慢性心衰合并2型糖尿病患者中的临床意义及诊断价值。方法:选取2019年07月至2019年12月于湖南师范大学附属长沙医院心内科住院且NYHA心功能分级为Ⅱ~Ⅳ级的慢性心力衰竭患者共116例。根据慢性心力衰竭患者是否合并2型糖尿病,分为慢性心力衰竭合并2型糖尿病组(研究组共41例),其中男性22例,女性19例,平均年龄为74.1±9.5岁,慢性心力衰竭组(对照组共75例),男性44例,女性31例,平均年龄为74.4±9.6岁。收集两组患者的一般临床资料、实验室检查及心脏超声资料。采用双抗夹心酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)测定血清中sST2水平。采用SPSS21.0软件进行统计学分析,运用双侧检验,P<0.05认为差异有统计学意义。结果:1.研究组与对照组在性别、年龄之间的差异无统计学意义(P>0.05),两组之间在血常规、ALT、BUN、Cr、UA、TG、CRP的差异无统计学意义(P>0.05),在TC、GLU之间的差异有统计学意义(分别为P<0.05,P<0.01)。两组之间在血清BNP水平的差异有统计学意义(P<0.05)。两组之间在左室射血分数(LVEF)及左心室舒张末期内径(LVEDd)的差异均无统计学意义(P>0.05)。2.两组之间在血清sST2的差异无统计学意义(P>0.05)。两组间相同心功能分级患者的sST2水平比较无统计学差异(P>0.05);同组中,随着心功能分级的增加,血清sST2水平升高(P<0.05)。3.研究组与对照组中s ST2水平与BNP呈正相关性(相关系数r=0.311,P<0.05;相关系数r=0.481,P<0.01),两组sST2水平与LVEDd呈正相关性(相关系数r=0.361,P<0.05;相关系数r=0.242,P<0.05)。两组sST2水平与LVEF、血糖值无相关性。4.在研究组中,s ST2诊断慢性心衰合并2型糖尿病的受试者工作特征(receiver Operating Characteristic,ROC)曲线下面积(area Under the Curve,AUC)为0.824,最佳截断值为169.014ng/ml,灵敏度及特异度分别是0.610和1.000。BNP的AUC为0.927,两者联合检测的AUC为0.936。在对照组中,sST2诊断慢性心衰的ROC曲线下面积为0.901,最佳截断值为166.489ng/ml,灵敏度及特异度分别是0.787和1.000。BNP的AUC为0.956,两者联合检测AUC为0.971。在两组中对sST2和BNP进行联合检测可提高诊断效价。结论:1、无论慢性心衰是否合并2型糖尿病,血清sST2水平与BNP、LVEDd均呈正相关,且血清sST2水平随着心功能分级的增加而升高。而与是否合并2型糖尿病无明显相关性。2、根据ROC曲线分析得出无论慢性心衰是否合并2型糖尿病,血清s ST2水平对慢性心衰具有一定的临床诊断价值,与BNP进行联合检测可提高诊断效价。更多还原

【Abstract】 Objective: Comparing the changes of serum sST2 levels in patients with chronic heart failure and chronic heart failure with type 2 diabetes and Through the ROC curve analysis method,explore the clinical significance and diagnostic value of sST2 in patients with chronic heart failure and type 2 diabetes.Methods: Choose between July 2019 and December 2019 in hunan normal university affiliated hospital of changsha cardiology,hospitalization and NYHA heart function classification is Ⅱ~Ⅳ level,a total of 116 patients with chronic heart failure.According to whether chronic heart failure patients with type 2 diabetes,the patients were divided into chronic heart failure with type 2 diabetes group(a total of41 cases in the study group),including 22 males and 19 females,with an average age of 74.1±9.5 years,and chronic heart failure group(a total of75 cases in the control group),44 males and 31 females,with an average age of 74.4±9.6 years.General clinical data,laboratory examination and cardiac ultrasound data of patients in the two groups were collected.Serum sST2 levels were determined by enzyme linked immunosorbent assay(ELISA).SPSS21.0 software was used for statistical analysis,and bilateral test was used,P<0.05 was considered asstatistically significant.Results:1.There were no statistically significant differences between the study group and the control group in gender and age(P>0.05),no statistically significant differences between the two groups in blood routine,ALT,BUN,Cr,UA,TG and CRP(P>0.05),and statistically significant differences between TC and GLU(P<0.05,P<0.01,respectively).The difference in serum BNP level between the two groups was statistically significant(P<0.05).There was no significant difference in left ventricular ejection fraction(LVEF)and left ventricular end-diastolic diameter(LVEDd)between the two groups(P>0.05).2.There was no significant difference in serum sST2 between the two groups(P>0.05).There was no statistical difference between the two groups of patients with the same cardiac function grade(P>0.05);In the same group,with the increase of cardiac function grade,the serum sST2 level increased(P<0.05).3.The sST2 level in the study group and the control group was positively correlated with BNP(correlation coefficient r=0.311,P<0.05;correlation coefficient r=0.481,P<0.01),and the sST2 level in both groups was positively correlated with LVEDd(correlation coefficient r=0.361,P<0.05;correlation coefficient r=0.242,P<0.05).There was no correlation between sST2 level and LVEF and blood glucose level in thetwo groups.4.In the study group,the area under the ROC curve for sST2 diagnosis was 0.824,the optimal cut-off value was 169.014ng/ml,and the sensitivity and specificity were 0.610 and 1.000,respectively.The AUC of BNP was 0.927,the combined AUC of the two was 0.936.In the control group,the area under the ROC curve for sST2 diagnosis was 0.901,the optimal cut-off value was 166.489ng/ml,and the sensitivity and specificity were 0.787 and 1.000,respectively.The AUC of BNP was0.956,the combined AUC of the two was 0.971.Combined detection of s ST2 and BNP in both groups increased diagnostic titer.Conclusion:1.Whether or not chronic heart failure is associated with type 2diabetes,serum sST2 level is positively correlated with BNP and LVEDd,and serum s ST2 level increases with the increase of cardiac function grade.There is no obvious correlation with whether type 2 diabetes is combined.2.According to ROC curve analysis,serum sST2 level has certain clinical diagnostic value for chronic heart failure,regardless of whether chronic heart failure is complicated with type 2 diabetes,and combined detection with BNP can improve diagnostic titer.更多还原