心力衰竭患者B型利钠肽、B型氨基端利钠肽原和可溶性ST2水平变化及意义

摘要

目的 探讨B型利钠肽(BNP)、B型氨基端利钠肽原(NT-proBNP)、白细胞介素-1受体家族成员可溶性ST2(sST2)在心力衰竭(以下简称心衰)患者中的水平变化及临床意义.方法 回顾性分析84例心衰患者(心衰组)血BNP、NT-proBNP、sST2浓度,采用纽约心脏病学会(NYHA)标准对心功能分级和超声心动图检查评定患者心功能,以同期住院的95例无心衰的患者作为对照组.分析3个指标与左室射血分数(LVEF)、NYHA心功能分级的相关性,并比较3个指标在不同心功能级别患者之间血水平的差异.结果 与对照组相比,心衰组血BNP、NT-proBNP、ST2水平升高,差异有统计学意义(P＜0.01).心衰组随NYHA分级增加,BNP、NT-proB-NP、sST2水平逐渐升高,不同心功能级别间3个指标水平差异均有统计学意义(P＜0.01),3个指标水平与心功能分级呈明显正相关性,与LVEF分级呈负相关.诊断心衰的ROC曲线下面积BNP为0.868,NT-proBNP为0.957,sST2为0.758,3个指标曲线下面积差异有统计学意义(P＜0.01).结论 BNP、NT-proBNP和ST2是心衰诊断的标志物,血水平检测对不同程度心衰的鉴别诊断、危险分层、指导临床治疗具有重要临床价值.sST2作为诊断心衰新的标志物,与LVEF、心功能分级相关,可用于判断心衰严重程度及心功能危险分层.独立诊断心衰价值较好的指标依次是NT-proBNP、BNP、sST2.%Objective To evaluate the clinical significance of B-type natriuretic peptide (BNP),N-terminal pronatriuretic peptide (NT-proBNP) and serum soluble ST2 (sST2) monitoring.Methods A total of 179 patients with and without symptoms of heart failure (HF) were included in this retrospective study.According to the classification criteria of New York Heart Association (NYHA),eighty-four HF patients were regarded with the observation group (HF group),while the other 95 contemporaneous in-patients without HF were assigned as control group.The serum concentrations of BNP and sST2 were measured by enzyme-linked immunoabsorbent assay,while NT-proBNP was assessed by the immunochromatographic assay.Associations between BNP,NT-proBNP,sST2 and left ventricular ejection fraction (LVEF) were analyzed; additionally,the serum concentration changes of BNP,NT-proBNP,sST2 according to NYHA cardiac classes were viewed and compared.Results There were significant differences in BNP,NT-proBNP and sST2 concentrations between HF group and control group (P ＜ 0.01).They were significantly increased in patients with HF;and positively correlated with NYHA class but negatively correlated with LVEF.The blood concentrations of the markers were higher along with NYHA classification of cardiac function (P ＜ 0.05).According to receiver operating characteristic curve analysis,ther area under the curve for BNP,NT-proBNP and sST2 were 0.868,0.957 and 0.758,respectively,for the diagnosis of HF.Conclusion BNP,NT-proBNP and sST2 are novel biomarker for cardiac stress in patients with HF,and can be used diagnosing HF and evaluating cardiac function.In HF diagnosis,NT-proBNP is superior to BNP and sST2.