van Kimmenade Roland R, Januzzi James L, Ellinor Patrick T, Sharma Umesh C, Bakker Jaap A, Low Adrian F, Martinez Abelardo, Crijns Harry J, MacRae Calum A, Menheere Paul P, Pinto Yigal M
Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands.
J Am Coll Cardiol. 2006 Sep 19;48(6):1217-24. doi: 10.1016/j.jacc.2006.03.061. Epub 2006 Aug 28.
This study sought to explore the role of new biomarkers in heart failure (HF).
We investigated the utility of novel serum markers alone or together with natriuretic peptide testing for diagnosis and short-term prognosis estimation in subjects with acute HF.
Plasma levels of amino-terminal pro-brain natriuretic peptide (NT-proBNP), apelin, and galectin-3 were measured in 599 patients presenting with dyspnea at the emergency department, of which 209 (35%) had acute HF.
The NT-proBNP was superior to either apelin or galectin-3 for diagnosis of acute HF, although galectin-3 levels were significantly higher in subjects with HF compared with those without. Receiver operating characteristic analysis for mortality prediction showed that, for 60-day prognosis, galectin-3 had the greatest area under the curve (AUC) at 0.74 (p = 0.0001), whereas NT-proBNP and apelin had an AUC of 0.67 (p = 0.009) and 0.54 (p = 0.33). In a multivariate logistic regression analysis, an elevated level of galectin-3 was the best independent predictor of 60-day mortality (odds ratio 10.3, p < 0.01) or the combination of death/recurrent HF within 60 days (odds ratio 14.3, p < 0.001). The Kaplan-Meier analyses showed that the combination of an elevated galectin-3 with NT-proBNP was a better predictor of mortality than either of the 2 markers alone.
Our data show potential utility of galectin-3 as a useful marker for evaluation of patients with suspected or proven acute HF, whereas apelin measurement was not useful for these indications. Moreover, the combination of galectin-3 with NT-proBNP was the best predictor for prognosis in subjects with acute HF.
本研究旨在探讨新生物标志物在心力衰竭（HF）中的作用。
我们研究了新型血清标志物单独使用或与利钠肽检测联合用于急性HF患者诊断和短期预后评估的效用。
在急诊科因呼吸困难就诊的599例患者中检测了氨基末端脑钠肽前体（NT-proBNP）、Apelin和半乳糖凝集素-3的血浆水平，其中209例（35%）患有急性HF。
NT-proBNP在诊断急性HF方面优于Apelin或半乳糖凝集素-3，尽管HF患者的半乳糖凝集素-3水平显著高于非HF患者。死亡率预测的受试者工作特征分析表明，对于60天预后，半乳糖凝集素-3的曲线下面积（AUC）最大，为0.74（p = 0.0001），而NT-proBNP和Apelin的AUC分别为0.67（p = 0.009）和0.54（p = 0.33）。在多因素逻辑回归分析中，半乳糖凝集素-3水平升高是60天死亡率（比值比10.3，p < 0.01）或60天内死亡/再发HF组合（比值比14.3，p < 0.001）的最佳独立预测指标。Kaplan-Meier分析表明，半乳糖凝集素-3升高与NT-proBNP联合使用比单独使用这两种标志物中的任何一种更能预测死亡率。
我们的数据表明，半乳糖凝集素-3作为评估疑似或确诊急性HF患者的有用标志物具有潜在效用，而检测Apelin对这些指征无用。此外，半乳糖凝集素-3与NT-proBNP联合使用是急性HF患者预后的最佳预测指标。
