Diagnostic and prognostic values of N-terminal brain natriuretic peptide,B-brain natriuretic peptide and soluble ST2 in patients with heart failure
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摘要: 目的：分析心力衰竭（HF）患者N端脑钠肽前体（NT-proBNP）、B型钠尿肽（BNP）、可溶性人基质裂解素（sST2）的临床诊断及预后价值。方法：153例HF患者（HF组）分别测定血NT-proBNP、BNP与sST2水平。参照NYHA心功能分级将HF患者分Ⅱ级（73例）、Ⅲ级（56例）、Ⅳ级（24例）。另选取同期健康体检者共75例作为对照组。综合统计分析HF患者不同心功能分级组间NT-proBNP、BNP与sST2水平变化；比较NT-proBNP、BNP、sST2及3指标联合对HF患者死亡状况的预测价值。应用多因素Cox回归模型分析NT-proBNP、BNP、sST2水平与HF患者死亡的相关性。结果：与对照组相比，HF组NT-proBNP、BNP和sST2水平明显升高（均P<0.01）。随着NYHA分级增加，HF患者血中NT-proBNP、BNP和sST2水平也相应升高（均P<0.05）。ROC结果表明，sST2诊断HF的ROC曲线下面积略高于NT-proBNP、BNP，分别为0.921、0.908、0.890（均P<0.05）。随访死亡患者11例（7.19%）；1年内死亡患者血NT-proBNP、BNP、sST2水平明显高于未死亡患者（均P<0.05）；多因素Cox回归模型分析发现，患者基线NT-proBNP、BNP、sST2水平与死亡明显相关（OR=1.86）；sST2对预后判断的ROC曲线下面积（0.792）与BNP （0.778）、NT-proBNP （0.801）差异不大，而三者联合应用预测效果（0.859）明显提高。结论：HF患者血NT-proBNP、BNP、sST2水平与临床及生化变量密切相关，三者联合应用能够增强对HF患者死亡的预测能力。Abstract: Objective: To analyse values of clinical diagnosis and prognosis of N-terminal brain natriuretic peptide (NT-proBNP), B-brain natriuretic peptide (BNP) and soluble matrix cracking element (sST2) in patients with heart failure (HF). Method: A total of 153 patients with HF (HF group) were included, and levels of blood NT-proBNP, BNP and sST2 were separately measured. All patients were included into NYHAⅡ (n=73), NYHA Ⅲ (n=56) and NYHA Ⅳ(n=24) group. Other 75 healthy cases were choose as the control group. Levels of NT-proBNP, BNP and sST2 were compared between the groups with different heart function classification; the predictive values of NT-proBNP, BNP, sST2 and combination of the three indexes in the death were compared. Multiariable Cox regression model was used to analyze the correlation among NT-proBNP, BNP and sST2 with the death in patients with HF.Result: Compared with control group, levels of NT-proBNP, BNP and sST2 increased significantly in HF group, and increased with the increase of NYHA classification (all P<0.05). ROC results showed that the area under ROC (AUC) of sST2 (0.921) was slightly higher than those of NT-proBNP (0.908) and BNP (0.890) (all P<0.05). Followed up for 1 years, 11 patients (7.19%) were dead and whose NT-proBNP, BNP and sST2 levels were significantly higher than survivors (all P<0.05). Multiariable Cox analysis found that baseline NT-proBNP, BNP and sST2 levels were significantly related with death (OR=1.86). The AUC of sST2 for prognosis judgment was 0.792, similar to BNP (AUC=0.778) and NT-proBNP (AUC=0.801) but higher than the combine of the three indexes (AUC=0.859). Conclusion: Blood NT-proBNP, BNP and sST2 levels are closely related to clinical and biochemical variables in patients with HF. Combination application of the three indexes can enhance the prediction ability of death.
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