摘要
目的 探讨可溶性生长刺激表达基因2蛋白(sST-2)、超敏C反应蛋白(hs-CRP)、N末端B型脑钠肽前体(NT-proBNP)、胰岛素样生长因子-1(IGF-1)水平与慢性心力衰竭(CHF)严重程度的关系。方法选取2023年1月—2024年6月山东大学齐鲁医院德州医院收治的73例慢性心力衰竭患者为心衰组,选取该院同期健康体检者80例作为对照组。比较两组血清sST-2、hs-CRP、NT-proBNP、IGF-1水平。将心衰组按左室射血分数(LVEF)分为射血分数降低型(HFrEF)组、射血分数轻度降低型(HFmrEF)组、射血分数保留型(HFpEF)组,比较3个亚组患者血清sST-2、hs-CRP、NT-proBNP、IGF-1水平;采用多因素逐步Logistic回归分析心力衰竭的影响因素;Spearman相关性分析血清sST-2、hs-CRP、NT-proBNP水平与心力衰竭严重程度的相关性;绘制受试者工作特征(ROC)曲线分析血清sST-2、hs-CRP、NT-proBNP水平及三者联合对心力衰竭严重程度的诊断价值。结果 心衰组血清sST-2、hs-CRP、NT-proBNP水平均高于对照组(P <0.05),IGF-1低于对照组(P <0.05)。HFrEF组血清sST-2、hs-CRP、NT-proBNP水平均高于HFmrEF组和HFpEF组(P <0.05),HFmrEF组血清sST-2、hs-CRP、NT-proBNP水平均高于HFpEF组(P <0.05);3个亚组患者血清IGF-1水平比较,差异无统计学意义(P>0.05)。Spearman相关性分析结果显示,sST-2、hs-CRP、NT-proBNP水平与LVEF呈负相关(P <0.05),与LVEDD、LVEF分级均呈正相关(P <0.05)。多因素逐步Logistic回归分析结果显示:LVEF [O^R=0.679(95%CI:0.514,0.897)]为为心力衰竭严重程度的保护因素(P <0.05),LVEDD [O^R=1.224(95%CI:1.053,1.422)]、sST-2 [O^R=1.175(95%CI:1.007,1.372)]、hs-CRP [O^R=1.428(95%CI:1.021,1.998)]及NT-proBNP [O^R=1.001(95%CI:1.000,1.002)]均为心力衰竭严重程度的危险因素(P <0.05)。ROC曲线分析结果显示,sST-2、hs-CRP、NT-proBNP的曲线下面积分别为0.774、0.770、0.689,三者联合检测的曲线下面积为0.883,诊断价值高于任一单一指标。结论 血清sST-2、hs-CRP、NT-proBNP水平与慢性心力衰竭严重程度呈正相关,随心力衰竭严重程度增加而升高;sST-2、hs-CRP、NT-proBNP三者联合的诊断价值高于单一因素的诊断价值,诊断特异性高,可以为慢性心力衰竭严重程度的诊断提供新的思路。
Objective To investigate the correlation between the levels of soluble suppression of tumorigenicity 2(sST-2),high-sensitivity C-reactive protein(hs-CRP),N-terminal pro-B-type natriuretic peptide(NT-proBNP),and insulin-like growth factor-1(IGF-1)with the severity of chronic heart failure(CHF).Methods A total of 73 patients with CHF admitted to Dezhou Hospital of Qilu Hospital,Shandong University,from January 2023 to June 2024,were selected as the heart failure group,while 80 healthy individuals undergoing physical examinations were selected as the control group.Serum levels of sST-2,hs-CRP,NT-proBNP and IGF-1 were compared between the two groups.The CHF group was further divided into three subgroups based on left ventricular ejection fraction(LVEF):heart failure with reduced ejection fraction(HFrEF),heart failure with mildly reduced ejection fraction(HFmrEF),and heart failure with preserved ejection fraction(HFpEF).The serum levels of IGF-1,sST-2,and hs-CRP among the three subgroups were compared.The correlation between serum levels of sST-2,hs-CRP,NT-proBNP,and CHF severity,as well as their diagnostic value for CHF severity,was analyzed.Multivariate stepwise Logistic regression was used to analyze the influencing factors of heart failure.Spearman correlation analysis was performed to assess the relationship between serum sST-2,hs-CRP,and NT-proBNP levels and the severity of heart failure.Receiver operating characteristic(ROC)curves were plotted to evaluate the diagnostic value of serum sST-2,hs-CRP,NT-proBNP levels,and their combined assessment for the severity of heart failure.Results Serum levels of sST-2,hs-CRP,and NT-proBNP in the CHF group were significantly higher than those in the control group(P<0.05),while IGF-1 levels were lower(P<0.05).The HFrEF subgroup exhibited significantly higher serum levels of sST-2,hs-CRP,and NT-proBNP compared to the HFmrEF and HFpEF subgroups(P<0.05),and the HFmrEF subgroup showed higher levels than the HFpEF subgroup(P<0.05).Spearman correlation analysis indicated that sST-2,hs-CRP,and NT-proBNP levels were negatively correlated with LVEF and positively correlated with left ventricular end-diastolic diameter(LVEDD)and LVEF grading(P<0.05).The results of the multivariate stepwise logistic regression analysis showed that LVEF[O^R=0.679(95%CI:0.514,0.897)]was a protective factor(P<0.05),while LVEDD[O^R=1.224(95%CI:1.053,1.422)],sST-2[O^R=1.175(95%CI:1.007,1.372)],hs-CRP[O^R=1.428(95%CI:1.021,1.998)],and NT-proBNP[O^R=1.001(95%CI:1.000,1.002)]were all risk factors for the severity of heart failure(P<0.05).The results of the ROC curve analysis showed that the areas under the curve for sST-2,hs-CRP,and NT-proBNP were 0.774,0.770,and 0.689,respectively.The area under the curve for the combined detection of the three indicators was 0.883,which had a higher diagnostic value than any single indicator.Conclusion Serum levels of sST-2,hs-CRP,and NT-proBNP are positively correlated with the severity of CHF,increasing with the progression of the disease.The combined diagnostic value of sST-2,hs-CRP,and NTproBNP is higher than that of any single biomarker,providing high diagnostic specificity and offering a novel approach for assessing CHF severity.
作者
何璐
李慧
李玲玲
刘静
刘志勇
He Lu;Li Hui;Li Ling-ling;Liu Jing;Liu Zhi-yong(School of Clinical Medicine,Shandong Second Medical University,Weifang,Shandong 261000,China;Health Management Center,Qilu Hospital of Shandong University,Dezhou Hospital,Dezhou,Shandong253000,China;Department of Endocrinology,Qilu Hospital of Shandong University,Dezhou Hospital,Dezhou,Shandong 253000,China;Department of Cardiology,Qilu Hospital of Shandong University,Dezhou Hospital,Dezhou,Shandong 253000,China)
出处
《中国现代医学杂志》
2025年第9期13-20,共8页
China Journal of Modern Medicine
基金
山东省医药卫生科技发展计划项目(No:2021BJ000034)。
