| 白 杨,姜伟鹏,夏成蕴,刘玉建,邓小艳.血清NT-proBNP、HE4、β2-MG、sST2与扩张型心肌病患者心室重构的关系及对出院后短期预后的预测价值[J].,2022,(17):3259-3263 |
| 血清NT-proBNP、HE4、β2-MG、sST2与扩张型心肌病患者心室重构的关系及对出院后短期预后的预测价值 |
| Relationship between Serum NT-proBNP, HE4, β2-MG, sST2 and Ventricular Remodeling in Patients with Dilated Cardiomyopathy and the Predictive Value of Short-Term Prognosis after Discharge |
| 投稿时间：2022-02-26 修订日期：2022-03-22 |
| DOI：10.13241/j.cnki.pmb.2022.17.011 |
| 中文关键词: 扩张型心肌病 心室重构 NT-proBNP HE4 β2-MG sST2 预后 |
| 英文关键词: Dilated cardiomyopathy Ventricular remodeling NT-proBNP HE4 β2-MG sST2 Prognosis |
| 基金项目:湖北省自然科学基金项目（2017CFB464） |
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| 中文摘要: |
| 摘要 目的：探讨血清N端脑钠肽前体（NT-proBNP）、人附睾蛋白4（HE4）、β2微球蛋白（β2-MG）、可溶性ST2（sST2）与扩张型心肌病（DCM）患者心室重构的关系及对出院后短期预后的预测价值。方法：选取2019年3月～2020年12月华中科技大学同济医学院附属同济医院收治的DCM患者74例，记作DCM组。另取同期健康体检者80例作为对照组。检测并比较两组血清NT-proBNP、HE4、β2-MG、sST2水平以及心室重构相关指标水平。以Pearson相关性分析血清NT-proBNP、HE4、β2-MG、sST2水平和各项心室重构参数的相关性。此外，将所有DCM组患者按照出院后是否发生因心力衰竭再住院和心血管死亡事件分作预后不良组33例以及预后良好组41例。比较两组各项基线资料以及血清NT-proBNP、HE4、β2-MG、sST2水平。多因素Logistic回归分析DCM患者出院后短期预后的危险因素。通过受试者工作特征（ROC）曲线分析血清NT-proBNP、HE4、β2-MG、sST2预测DCM患者出院后短期预后的效能。结果：DCM组血清NT-proBNP、HE4、β2-MG、sST2水平均高于对照组（P＜0.05）。DCM组左心室质量指数（LVMI）、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）水平均高于对照组，而左心室射血分数（LVEF）水平低于对照组（P＜0.05）。经Pearson相关性分析可得：血清NT-proBNP、HE4、β2-MG、sST2水平与LVMI、LVEDV、LVESV均呈正相关关系，而和LVEF均呈负相关关系（P＜0.05）。预后不良组年龄以及血清NT-proBNP、HE4、β2-MG、sST2水平均高于预后良好组（P＜0.05）。经多因素Logistic回归分析发现，年龄以及血清NT-proBNP、HE4、β2-MG、sST2水平均是DCM患者出院后短期预后的危险因素（P＜0.05）。经ROC曲线分析可得：血清NT-proBNP、HE4、β2-MG、sST2联合检测预测DCM患者出院后短期预后的曲线下面积、灵敏度以及特异度均高于上述四项指标单独检测。结论：血清NT-proBNP、HE4、β2-MG、sST2与DCM患者心室重构密切相关，且在预测患者出院后短期预后方面价值较高。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the relationship between serum N-terminal brain natriuretic peptide precursor (NT-proBNP), human epididymal protein 4 (HE4), β2 microglobulin (β2-MG), soluble ST2 (sST2) and ventricular remodeling in patients with dilated cardiomyopathy (DCM) and the predictive value of short-term prognosis after discharge. Methods: 74 patients with DCM who were admitted to Tongji Hospital Affiliated to Tongji Medical College of HUST from March 2019 to December 2020 were selected, and were recorded as DCM group. Another 80 healthy subjects in the same period were taken as the control group. The levels of serum NT-proBNP, HE4, β2-MG and sST2 and related indexes of ventricular remodeling were detected and compared between the two groups. Pearson correlation was used to analyze the correlation between serum NT-proBNP, HE4, β2-MG, sST2 levels and various ventricular remodeling parameters. In addition, all patients with DCM were divided into the poor prognosis group with 33 cases and the good prognosis group with 41 cases according to whether rehospitalization for heart failure and cardiovascular death events had occurred after discharge. The baseline data and the levels of serum NT-proBNP, HE4, β2-MG and sST2 were compared between the two groups. Multivariate Logistic regression was used to analyze the risk factors for short-term prognosis in patients with DCM after discharge. The efficacy of serum NT-proBNP, HE4, β2-MG and sST2 in predicting short-term prognosis of patients with DCM after discharge was analyzed by receiver operating characteristic (ROC) curve. Results: The levels of serum NT-proBNP, HE4, β2-MG and sST2 in DCM group were higher than those in control group (P＜0.05). The levels of left ventricular mass index (LVMI), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) in DCM group were higher than those in control group, while the level of left ventricular ejection fraction (LVEF) was lower than that in control group (P＜0.05). Pearson correlation analysis showed that the levels of serum NT-proBNP, HE4, β2-MG and sST2 were positively correlated with LVMI, LVEDV and LVESV, while negatively correlated with LVEF (P＜0.05). The age and the levels of serum NT-proBNP, HE4, β2-MG and sST2 in the poor prognosis group were higher than those in the good prognosis group (P＜0.05). Multivariate Logistic regression analysis showed that age and the levels of serum NT-proBNP, HE4, β2-MG and sST2 were risk factors for short-term prognosis in patients with DCM after discharge (P＜0.05). ROC curve analysis showed that the area under curve, sensitivity and specificity of combined detection of serum NT-proBNP, HE4, β2-MG and sST2 in predicting short-term prognosis of patients with DCM after discharge were higher than those of the above four indicators alone. Conclusion: Serum NT-proBNP, HE4, β2-MG and sST2 are closely related to ventricular remodeling in patients with DCM, and have high value in predicting short-term prognosis after discharge. |
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