Huang Anan, Qi Xin, Hou Wenguang, Qi Yanfang, Zhao Na, Liu Keqaing
a School of Medicine , Nankai University , Tianjin , P.R. China.
b Department of Cardiology , Tianjin Union Medical Center, Nankai University Affiliated Hospital , Tianjin , P.R. China.
Acta Cardiol. 2018 Feb;73(1):41-48. doi: 10.1080/00015385.2017.1325617. Epub 2017 Sep 25.
The aim of this study was to compare sST2 at admission with N-terminal pro B-type natriuretic peptide (NT-proBNP) in prognostic accuracy among different types of heart failure (HF) and clarifying the enhanced prognostic value in patients with HF by the combination of the two biomarkers.
A total of 164 consecutive patients admitted to our institution for HF were divided into three groups of HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction (HFmrEF) and HF with preserved ejection fraction (HFpEF). Circulating sST2 and NT-proBNP were measured using the enzyme-linked immunosorbent assay (ELISA). The sST2 level was only significantly higher in HFrEF when compared with HFpEF. At ROC analysis to one-year adverse events, only sST2 showed predictive value in HFmrEF with an optimal cut-off value of 147.66 ng/ml (AUC 0.697, p = .045, sensitivity 75%, specificity 75.8%), while both NT-proBNP and sST2 showed a significant predictive value in HFpEF (p = .036 vs .042; AUC 0.683, sensitivity 71.4%, specificity 55.6%; AUC 0.677, sensitivity 64.3%, specificity 83.3%) with an optimal cut-off value of 1054.50 pg/ml and 117.80 ng/ml. Multivariate regression analysis suggested that sST2 and NT-proBNP could be biomarkers for predicting 1-year adverse events of HF (OR = 4.384, 95% CI = 1.661-11.570 vs. OR = 3.451, 95% CI = 1.254-9.497). Adverse events occurred frequently within one year both in sST2 and in NT-proBNP above the median.
sST2 can provide different prognostic information in distinct types of HF, and even be superior to NT-proBNP. sST2 combined with NT-proBNP can improve predicting accuracy.
本研究旨在比较入院时可溶性ST2（sST2）与N末端B型利钠肽原（NT-proBNP）在不同类型心力衰竭（HF）中的预后准确性，并阐明两种生物标志物联合应用对HF患者预后价值的增强作用。
共有164例因HF连续入住我院的患者被分为射血分数降低的HF（HFrEF）、射血分数中等范围的HF（HFmrEF）和射血分数保留的HF（HFpEF）三组。采用酶联免疫吸附测定（ELISA）法检测循环中的sST2和NT-proBNP。与HFpEF相比，仅HFrEF组的sST2水平显著更高。在对一年不良事件的ROC分析中，仅sST2在HFmrEF中显示出预测价值，最佳截断值为147.66 ng/ml（AUC 0.697，p = 0.045，敏感性75%，特异性75.8%），而NT-proBNP和sST2在HFpEF中均显示出显著的预测价值（p = 0.036对0.042；AUC 0.683，敏感性71.4%，特异性55.6%；AUC 0.677，敏感性64.3%，特异性83.3%），最佳截断值分别为1054.50 pg/ml和117.80 ng/ml。多因素回归分析表明，sST2和NT-proBNP可作为预测HF患者1年不良事件的生物标志物（OR = 4.384，95%CI = 1.661 - 11.570对OR = 3.451，95%CI = 1.254 - 9.497）。sST2和NT-proBNP高于中位数的患者在一年内不良事件频繁发生。
sST2可在不同类型的HF中提供不同的预后信息，甚至优于NT-proBNP。sST2与NT-proBNP联合应用可提高预测准确性。
