三种生物学标志物在心力衰竭患者诊断中的应用

摘要

目的 探讨B型钠尿肽(BNP)、N末端B型钠尿肽前体(NT-proBNP)、可溶性生长刺激表达基因2蛋白(ST2)水平在心力衰竭(心衰)患者诊断中的应用价值.方法 选取在我院心内科住院的心衰患者97例为心衰组,按照心功能分级(NYHA)Ⅱ级32例,Ⅲ级36例和Ⅳ级29例,另选同期住院的非心衰患者61例为对照组,测定可溶性ST2与BNP和NT-proBNP水平,分析其对心衰的诊断价值.结果 心衰组患者的BNP、NT-proBNP、可溶性ST2水平明显高于对照组,差异均有统计学意义(中位数,396.0 ng/L vs 39.4 ng/L,P＜0.01;1825.0 ng/L vs215.0 ng/L,P＜0.01;56.8 μg/L vs 25.4 μg/L,P＜0.01);且随着心功能级别增高,BNP、NT-proBNP、可溶性ST2水平逐渐增高(P＜0.01).BNP、NT-proBNP、可溶性ST2诊断心力衰竭的ROC曲线下面积分别为0.874、0.891、0.842,NT-proBNP和可溶性ST2两项联合诊断心衰的ROC曲线下的面积为0.905.结论 通过BNP、NT-proBNP、可溶性ST2这3种生物学标志物的检测,可帮助临床提高对心衰的诊断价值.%Objective To study the application of BNP,NT-proBNP and ST2 in diagnosis of heart failure (HF).Methods Ninety-seven HF patients admitted to our hospital served as a HF group and 61 HF-free patients served as a control group.The patients in HF group were further divided in to class Ⅱ group (n=32),class Ⅲ group (n=36) and class Ⅳ group (n=29) according to their cardiac function in NYHA classification.The serum ST2,BNP and NT-proBNP levels were measured and their value in diagnosis of HF was analyzed.Results The serum BNP,NT-proBNP and ST2 levels were significantly higher in HF group than in control group (396.0 ng/L vs 39.4 ng/L,P＜0.01;1825.0 ng/L vs 215.0 ng/L,P＜0.01;56.8 μg/L vs 25.4 μg/L,P＜0.01),which increased with the increasing cardiac function in NYHA classification (P＜0.01).The area under the ROC curve for BNP,NT-proBNP,ST2,combined NT-proBNP and ST2 was 0.874,0.891,0.842,0.905 respectively for the diagnosis of HF.Conclusion BNP,NT-proBNP and ST2,3 new biomarkers,can improve the diagnosis of HF.