心力衰竭患者 B 型利钠肽、氨基末端 B 型利钠肽前体及可溶性 ST2水平变化及其临床意义

摘要

目的：探讨心力衰竭（HF）患者 B 型利钠肽（BNP）、氨基末端 B 型利钠肽前体（NT-proBNP）及可溶性 ST2（sST2）水平变化及其临床意义。方法选择宝鸡市第二人民医院心血管内科2013年10月—2014年9月收治的 HF 患者120例作为 HF 组，另选取同期心血管内科收治的无 HF 的其他心血管疾病患者100例作为对照组。比较两组及 HF 组不同心功能分级患者 BNP、NT-proBNP及 sST2水平，分析3者与心功能分级的关系，并绘制3者诊断 HF的受试者工作特征曲线（ROC 曲线）。结果 HF 组患者 BNP、NT-proBNP及 sST2水平均高于对照组（P ＜0.05）。心功能Ⅳ级患者 BNP、NT-proBNP及 sST2水平高于心功能Ⅲ级患者，心功能Ⅲ级患者 BNP、sST2水平高于心功能Ⅱ级患者（P ＜0.01）。BNP、sST2水平与心功能分级呈正相关（ r 值分别为0.662、0.569，P ＜0.05）。ROC 曲线显示，sST2、BNP 和NT-proBNP诊断 HF 的曲线下面积分别为0.651、0.791和0.822，截断点分别为0.42 ng/ L、136.2 ng/ L 和658.2 ng/ L，灵敏度分别为53.3%、80.0% 和66.7%，特异度分别为73.4%、86.7%和86.6%，符合率分别为63.3%、83.3%和73.3%。结论 HF 患者 BNP、NT-proBNP及 sST2水平升高，该3种指标对 HF 均有一定的诊断价值，且BNP、sST2水平与心功能分级有关。%Objective To investigate the changes and clinical significances of BNP,NT-proBNP and sST2 in patients with heart failure. Methods From October 2013 to September 2014 in the Department of Cardiovascular Disease,the Second Hospital of Baoji,120 patients with heart failure were selected as case group,100 patients with other cardiovascular diseases were selected as control group. BNP,NT-proBNP and sST2 were compared between the two groups and in heart failure patients with different NYHA cardiac functional grading,and their relations to NYHA cardiac functional grading were analyzed,ROC curve was draw to evaluate their diagnostic value on heart failure. Results BNP,NT-proBNP and sST2 of case group were statistically significantly higher than those of control group(P < 0. 05). BNP,NT-proBNP and sST2 of patients with Ⅳ - grade cardiac function were statistically significantly higher than those of patients with Ⅲ - grade cardiac function,while BNP and sST2 of patients with Ⅲ - grade cardiac function were statistically significantly higher than those of patients with Ⅱ - grade cardiac function(P < 0. 01). BNP,sST2 was positively correlated with NYHA cardiac functional grading,respectively( r = 0. 662, 0. 569,P < 0. 05). ROC curve showed that,AUC of BNP,NT-proBNP and sST2 on diagnosing heart failure was 0. 651, 0. 791,0. 822,respectively;cut - off point of BNP,NT-proBNP and sST2 was 0. 42 ng/ L,136. 2 ng/ L,658. 2 ng/ L, respectively;sensitivity of BNP,NT-proBNP and sST2 was 53. 3% ,80. 0% ,66. 7% ,respectively;specificity of BNP, NT-proBNP and sST2 was 73. 4% ,86. 7% ,86. 6% ,respectively;coincidence rate of BNP,NT-proBNP and sST2 was 63. 3% ,83. 3% ,73. 3% ,respectively. Conclusion BNP,NT-proBNP and sST2 are significantly increased,all of them have certain diagnostic value on heart failure,BNP and sST2 are positively correlated with NYHA cardiac functional grading.