心力衰竭患者B型钠尿肽、可溶性ST2和白介素33水平变化及其临床诊断价值

摘要

目的：：分析心力衰竭(HF)不同心功能分级患者 B 型钠尿肽(BNP)和可溶性人基质裂解素(sST2)、白细胞介素-33(IL-33)的血清水平变化及其与 HF 的关系,以及对 HF 的临床诊断价值。方法：211例 HF 患者(HF 组)分别测定血清 BNP、sST2、IL-33水平,并参照纽约心脏病协会(NYHA)心功能分级标准,将 HF 患者分为Ⅰ级(n=57)、Ⅱ级(n=96)、Ⅲ级(n=45)和Ⅳ级(n=13),另选同期体检健康者共75例作为对照组。统计分析 HF组与对照组、HF 患者不同心功能分级间 BNP、sST2和 IL-33的水平差异；logistic 回归分析 HF 危险因素；ROC 曲线分析 BNP、sST2对 HF 的诊断价值。结果：与对照组相比,HF 组 BNP 和 sST2水平明显升高(P <0.01),IL-33水平明显降低(P <0.01)。随着 NYHA 分级增加,HF 患者血清中 sST2和 BNP 水平也增加(P <0.05)。单因素回归分析显示上述三指标与 HF 相关性有统计学意义(P 均<0.01)；而多因素回归分析显示只有 BNP 为 HF 的独立危险因素(P <0.01)。ROC 结果表明,sST2诊断 HF 的 ROC 曲线下面积明显高于 BNP,分别为0.920 Vs 0.890(P <0.05),诊断价值优于 BNP。结论：正确选择应用有关生化标志物对筛选 HF 影响因素和诊断 HF 有重要临床实践意义。%Objective:To analyze heart failure (HF)patients with different heart function classification B-brain natriuretic peptide (BNP)and soluble matrix cracking element (sST2),interleukin 33(IL-33),analysis of the three myocardial cell stress biomarkers with the relationship between HF and the clinical diagnostic value.Method:21 1 patients with HF group (HF)were determined serum BNP,sST2,IL-33 level,and with reference to the New York heart association (NYHA)cardiac function grading HF patients divided into Ⅰ level (n=57),Ⅱ level (n=96),Ⅲ level (n=45),Ⅳ level (n=13),the other to choose the healthy physical examination,a total of 75 cases for the same period as the control group.Statistical analysis of HF group and control group,patients with HF BNP, sST2 between different cardiac function classification and the levels of IL-33 difference;Logistic regression analysis of risk factors for HF,ROC curve analysis the BNP,sST2 value to the diagnosis of HF.Results:Compared with control group,the BNP and the sST2 level HF group in were increased significantly (P <0.01),IL-33 level signifi-cantly decreased (P <0.01).With the increase of NYHA classification,Serum sST2 and BNP level in HF patients were increased (P <0.05).Single factor regression analysis showed that the above three indicators and HF correla-tion was statistically significant (P <0.01 ),and multiple factors regression analysis showed that only the BNP as independent risk factors for HF (P <0.01).ROC results show that sST2 diagnosis of HF area under the ROC curve was slightly higher than that of the BNP,0.920 Vs.0.890 respectively (P <0.05),and superior value to diagnosis the BNP.Conclusion:Proper application on biochemical markers for screening of HF influence factors and diagnosis of HF has important clinical significance.