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中华危重症医学杂志(电子版) ›› 2023, Vol. 16 ›› Issue (01) : 13 -19. doi: 10.3877/cma.j.issn.1674-6880.2023.01.003

论著

可溶性生长刺激表达基因2蛋白对急性心力衰竭住院患者的预后评估价值
刘一凡1, 高迪2, 董佳3, 朱凯媛1, 潘新4, 张风雷1, 徐大春5, 鄢春喜1,()   
  1. 1. 226299 江苏启东,江苏省启东市人民医院心内科
    2. 200030 上海,上海市徐汇区中心医院心内科
    3. 712046 陕西咸阳,陕西中医药大学附属医院心内科
    4. 200072 上海,同济大学附属第十人民医院老年科
    5. 200072 上海,同济大学附属第十人民医院心内科
  • 收稿日期:2022-10-19 出版日期:2023-02-28
  • 通信作者: 鄢春喜
  • 基金资助:
    国家自然科学基金项目(81770391); 上海申康医院发展中心第二轮【促进市级医院临床技能与临床创新三年行动计划(2020-2022年)】重大临床研究项目(SHDC2020CR3030B)

Prognostic value of soluble suppression of tumorigenicity-2 in hospitalized patients with acute heart failure

Yifan Liu1, Di Gao2, Jia Dong3, Kaiyuan Zhu1, Xin Pan4, Fenglei Zhang1, Dachun Xu5, Chunxi Yan1,()   

  1. 1. Department of Cardiology, Jiangsu Province Qidong People's Hospital, Qidong 226299, China
    2. Department of Cardiology, Shanghai Xuhui Central Hospital, Shanghai 200030, China
    3. Department of Cardiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang 712046, China
    4. Department of Geriatrics, Tenth People's Hospital of Tongji University, Shanghai 200072, China
    5. Department of Cardiology, Tenth People's Hospital of Tongji University, Shanghai 200072, China
  • Received:2022-10-19 Published:2023-02-28
  • Corresponding author: Chunxi Yan
引用本文:

刘一凡, 高迪, 董佳, 朱凯媛, 潘新, 张风雷, 徐大春, 鄢春喜. 可溶性生长刺激表达基因2蛋白对急性心力衰竭住院患者的预后评估价值[J/OL]. 中华危重症医学杂志(电子版), 2023, 16(01): 13-19.

Yifan Liu, Di Gao, Jia Dong, Kaiyuan Zhu, Xin Pan, Fenglei Zhang, Dachun Xu, Chunxi Yan. Prognostic value of soluble suppression of tumorigenicity-2 in hospitalized patients with acute heart failure[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(01): 13-19.

目的

探讨可溶性生长刺激表达基因2蛋白(sST2)评估心力衰竭严重程度及中期预后的临床价值。

方法

选择2018年12月至2019年6月收治的345例心力衰竭患者,根据患者sST2中位数水平,将其分为低sST2组(172例,sST2 < 12.99 μg/L)和高sST2组(173例,sST2 ≥ 12.99 μg/L)。记录所有患者的基线资料、终点事件包括心血管死亡和全因死亡。采用Kaplan-Meier法绘制两组患者的生存曲线,并用Cox比例风险回归模型评价验证sST2对心血管死亡和全因死亡的独立预测价值。

结果

高sST2组心力衰竭患者较低sST2组左心室射血分数水平更低,合并冠状动脉粥样硬化性心脏病更多,超敏肌钙蛋白T及N末端B型利钠肽前体水平均更高(P均< 0.05)。随着纽约心脏协会(NYHA)心功能分级的递增,sST2水平呈递增趋势(P < 0.001)。分别以全因死亡和心血管死亡为终点,高sST2组患者出院后生存率均低于低sST2组(χ2 = 28.352、28.461,P均< 0.001)。Cox多因素回归分析显示,校正相关危险因素后,sST2水平越高,患者全因死亡[风险比(HR)= 1.038,95%置信区间(CI)(1.022,1.055),P < 0.001]和心血管死亡[HR = 1.039,95%CI(1.023,1.055),P < 0.001]风险均越高。

结论

sST2与心力衰竭的严重程度及中期预后均具有高度关联性,提示其对心力衰竭的严重程度及预后的评估均具有较高的临床价值。

Objective

To investigate the value of soluble suppression of tumorigenicity-2 (sST2) in evaluating heart failure and predicting mid-term outcomes.

Methods

Totally 345 patients with heart failure hospitalized between December 2018 and June 2019 were enrolled, and then according to the median level of sST2, they were divided into a low sST2 group (172 patients, sST2 < 12.99 μg/L) and a high sST2 group (173 patients, sST2 ≥ 12.99 μg/L). The baseline data and endpoint events of cardiovascular and all-cause death were recorded for all patients. The survival curves for patients in both groups were drawn using the Kaplan-Meier method and the independent predictive value of sST2 for cardiovascular and all-cause mortality was evaluated using the Cox proportional hazards regression model.

Results

Patients with heart failure in the high sST2 group had lower levels of left ventricular ejection fraction, more complicated coronary atherosclerotic heart diseases, and higher levels of hypersensitive troponin T and N-terminal pro-B type natriuretic peptide than those in the low sST2 group (all P < 0.05). As the New York Heart Association (NYHA) cardiac function classification increased, the sST2 level gradually increased (P < 0.001). With the all-cause and cardiovascular death as endpoints respectively, the postdischarge survival rates of patients in the high sST2 group were lower than those in the low sST2 group (χ2 = 28.352, 28.461; both P < 0.001). Cox multivariate regression analysis showed that higher sST2 levels were associated with significantly increased risks of all-cause mortality [hazard ratio (HR) = 1.038, 95% confidence interval (CI) (1.022, 1.055), P < 0.001] and cardiovascular mortality [HR = 1.039, 95%CI (1.023, 1.055), P < 0.001] after adjusting for related risk factors.

Conclusions

Serum sST2 has good performance in evaluation of heart failure and prediction of mid-term outcomes. It might be a good biomarker for patients with heart failure.

表1 不同sST2水平心力衰竭患者的临床特征比较( ± s
图1 不同sST2水平心力衰竭患者的生存曲线注:sST2.可溶性生长刺激表达基因2蛋白;a图为全因死亡为终点的生存曲线;b图为心血管死亡为终点的生存曲线
表2 sST2与心力衰竭患者全因死亡风险的单因素Cox回归分析
表3 sST2与心力衰竭患者心血管死亡风险的单因素Cox回归分析
表4 sST2与心力衰竭患者全因死亡风险的多因素Cox回归分析
表5 sST2与心力衰竭患者心血管死亡风险的多因素Cox回归分析
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