可溶性生长刺激表达基因2蛋白（sST2）对特发性炎性肌病亚临床心脏受累阶段心肌纤维化的诊断价值。
The diagnostic value of sST2 for myocardial fibrosis in idiopathic inflammatory myopathies in subclinical stage of cardiac involvement.
作者信息
Sun Jianhong, Xu Yuanwei, Wu Yang, Sun Jiayu, Yin Geng, Chen Yucheng, Xie Qibing
机构信息
Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Cardiovascular Division, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
出版信息
Rheumatology (Oxford). 2024 Apr 2;63(4):1172-1179. doi: 10.1093/rheumatology/kead182.
OBJECTIVE
Myocardial fibrosis occurs in the early subclinical stage of cardiac involvement in idiopathic inflammatory myopathies (IIMs). Soluble suppression of tumorigenicity 2 (sST2) is known to have an immunomodulatory impact during autoimmune disease development. The current study investigated the diagnostic value of sST2 for myocardial fibrosis during early stage of cardiac involvement in IIM.
METHODS
A total of 44 IIM patients with normal heart function and 32 age- and gender-matched healthy controls (HCs) were enrolled. Serum sST2 levels were measured by ELISA and cardiac magnetic resonance (CMR) parameters for myocardial fibrosis [native T1, extracellular volume (ECV), late-gadolinium enhancement (LGE)] and oedema (T2 values) were analysed.
RESULTS
IIM patients had significantly higher sST2 levels than HCs [67.5 ng/ml (s.d. 30.4)] vs 14.4 (5.5), P < 0.001] and levels correlated positively with diffuse myocardial fibrosis parameters, native T1 (r = 0.531, P = 0.000), ECV (r = 0.371, P = 0.013) and focal myocardial fibrosis index and LGE (r = 0.339, P = 0.024) by Spearman's correlation analysis. sST2 was an independent predictive factor for diffuse and focal myocardial fibrosis after adjustment for age, gender, BMI and ESR. Risk increased ≈15.4% for diffuse [odds ratio (OR) 1.154 (95% CI 1.021, 1.305), P = 0.022] and 3.8% for focal [OR 1.038 (95% CI 1.006, 1.072), P = 0.020] myocardial fibrosis per unit increase of sST2. Cut-off values for diagnosing diffuse and focal myocardial fibrosis were sST2 ≥51.3 ng/ml [area under the curve (AUC) = 0.942, sensitivity = 85.7%, specificity = 98.9%, P < 0.001] and 53.3 ng/ml (AUC = 0.753, sensitivity = 87.5%, specificity = 58.3%, P < 0.01), respectively.
CONCLUSION
sST2 showed a marked elevation during the subclinical stage of cardiac involvement in IIM and has potential as a biomarker for predicting diffuse and focal myocardial fibrosis in IIM.
目的
心肌纤维化发生于特发性炎性肌病（IIM）心脏受累的早期亚临床阶段。已知可溶性肿瘤抑制因子2（sST2）在自身免疫性疾病发展过程中具有免疫调节作用。本研究探讨sST2在IIM心脏受累早期阶段对心肌纤维化的诊断价值。
方法
共纳入44例心功能正常的IIM患者及32例年龄和性别匹配的健康对照者（HC）。采用酶联免疫吸附测定法（ELISA）检测血清sST2水平，并分析心肌纤维化的心脏磁共振（CMR）参数[固有T1、细胞外容积（ECV）、钆延迟强化（LGE）]及水肿（T2值）。
结果
IIM患者的sST2水平显著高于HC[67.5 ng/ml（标准差30.4）vs 14.4（5.5），P<0.001]，且sST2水平与弥漫性心肌纤维化参数固有T1（r=0.531，P=0.000）、ECV（r=0.371，P=0.013）以及局灶性心肌纤维化指数和LGE（r=0.339，P=0.024）呈正相关，采用Spearman相关性分析。在校正年龄、性别、体重指数和红细胞沉降率后，sST2是弥漫性和局灶性心肌纤维化的独立预测因子。sST2每单位增加，弥漫性心肌纤维化风险增加约15.4%[比值比（OR）1.154（95%可信区间1.021，1.305），P=0.022]，局灶性心肌纤维化风险增加3.8%[OR 1.038（95%可信区间1.006，1.072），P=0.020]。诊断弥漫性和局灶性心肌纤维化的截断值分别为sST2≥51.3 ng/ml[曲线下面积（AUC）=0.942，敏感性=85.7%，特异性=98.9%，P<0.001]和53.3 ng/ml（AUC=0.753，敏感性=87.5%，特异性=58.3%，P<0.01）。
结论
sST2在IIM心脏受累的亚临床阶段显著升高，有潜力作为预测IIM中弥漫性和局灶性心肌纤维化的生物标志物。
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