摘要
目的通过检测不同纽约心脏病学会心功能分级(NYHA class)下心衰患者血清可溶性肿瘤因子2抑制剂(sST2)和半乳糖凝集素-3(Galectin-3)蛋白水平,明确其在优化心功能分级及预测心衰预后方面的价值。方法选取2015年4月至2016年1月山东大学附属省立医院心血管中心住院的心衰患者191例,其中男115例,女76例,40～90岁,平均(62.36±11.09)岁。按NYHA心功能分级(Ⅰ～Ⅳ组)及随访结果分为未发生心脏事件组、心衰恶化组和死亡组,检测入院sST2、galectin-3蛋白水平。每2个月对患者随访1次,记录心脏事件(因心衰恶化再入院或全因死亡)的发生。结果血清中sST2、galectin-3蛋白水平与NYHA心功能分级及左心室射血分数(LVEF)的相关性差异有统计学意义,与NYHA心功能分级呈正相关(r1=0.33,P_1<0.001; r_2=0.21,P_2=0.004),与LVEF呈负相关(r1=-0.25,P_1=0.001; r_2=-0.24,P_2=0.002)。血清中sST2、galectin-3蛋白水平在未发生心脏事件组、心衰恶化组、死亡组之间差异均有统计学意义(F_1=56.76,P_1<0.001; F_2=31.08,P_2<0.001),未发生心脏事件组与心衰恶化组、未发生心脏事件组与死亡组、心衰恶化组与死亡组血清sST2水平差异均有统计学意义(t1=6.15,P_1<0.001; t2=11.36,P_2<0.001; t3=3.22,P3=0.003);未发生心脏事件组与心衰恶化组、未发生心脏事件组与死亡组的galectin-3水平差异有统计学意义(t1=6. 28,P_1<0. 001; t2=5. 91,P_2<0. 001)。Galectin-3 <15. 67 ng/mL、sST2 <31.74 ng/mL是心衰患者不发生心脏事件的预测因子; sST2> 45. 031 ng/mL是心衰患者近期死亡的预测因子,galectin-3>21.90 ng/mL且sST2>45.03 ng/mL患者生存时间更短。结论血清galectin-3、sST2水平与NYHA心功能分级呈低度正相关,在一定程度上可反映心衰患者心功能状态。血清sST2水平对预测患者的预后(死亡、心衰恶化或未发生心脏事件),galectin-3水平对预测心衰患者心脏事件发生,以及两者联合检测对心衰诊断及预后评估有一定的辅助参考价值。
Objective To investigate the value of soluble suppression of tumorigenicity 2(sST2)and galectin-3(Gal-3)in heart failure grading and prognosis by evaluating their levels according to New York Heart Association(NYHA)classification. Methods A total of 191 patients with chronic heart failure treated during Apr. 2015 and Jan. 2016 were chosen randomly, including 115 males and 76 females, average(62.36±11.09)years. According to the NYHA criteria and follow-up results, the patients were classified into three groups: non-cardiac events group, rehospitalization group and death group. Plasma sST2 and Gal-3 levels were measured at admission and every 2 months during follow-up. The incidence of cardiac events were recorded. Results The levels of sST2 and Gal-3 were positively correlated with NYHA classification(r1=0.33, P1<0.001;r2=0.21, P2=0.004), and negatively correlated with left ventricular ejection fraction(LVEF)(r1=-0.25, P1=0.001;r2=-0.24, P2=0.002). There were significant differences in sST2 and Gal-3 levels among the three groups (F1=56.76, P1<0.001;F2=31.08, P2<0.001). The level of sST2 was significantly different between the non-cardiac events group and rehospitalization group, between the non-cardiac events group and death group, and between the rehospitalization group and death group(t1=6.15, P1<0.001;t2=11.36, P2<0.001;t3=3.22, P3=0.003). The level of Gal-3 was significantly different between the non-cardiac events group and rehospitalization group, and between the non-cardiac events group and death group(t1=6.28, P1<0.001;t2=5.91, P2<0.001). Gal-3<15.67 ng/mL and sST2< 31.74 ng/mL were the predictive factors of non-cardiac events. sST2 >45.031 ng/mL was a predictive factor of recent mortality. Gal-3 >21.90 ng/mL and sST2 >45.03ng/mL were predictors of shortened survival. Conclusion The levels of Gal-3 and sST2 are somewhat positively correlated with NYHA classification, and can indicate the cardiac function of patients with heart failure. The sST2 level is useful to predict patients' prognosis, including death, rehospitalization or non-cardiac events, while Gal-3 level is useful to predict cardiac events. The combined detection of them is valuable for the diagnosis and prognosis of heart failure.
作者
米传晓
刘军妮
邹承伟
周南南
MI Chuanxiao;LIU Junni;ZOU Chengwei;ZHOU Nannan(Department of Cardiac Surgery,Shandong Provincial Hospital Affiliated to Shandong University,Jinan 250021,Shandong,China;Department of Geriatric Cardiology,Shandong Provincial Hospital Affiliated to Shandong University,Jinan 250021,Shandong,China)
出处
《山东大学学报（医学版）》
CAS
北大核心
2019年第1期62-67,共6页
Journal of Shandong University:Health Sciences
基金
山东省科技发展计划(2014GGH2018011)
山东省医药卫生科技发展计划(2014WS0080
2015BJYB04)
2018-2020年国家青年基金(81701385)
