可溶性肿瘤发生抑制因子2（sST2）在维持性血液透析心力衰竭患者中的价值。
The value of soluble suppression of tumorigenesis-2 (sST2) in the maintenance of hemodialysis patients with heart failure.
作者信息
Zhou X, Yi F, Peng L, Jiang J, Lan L
机构信息
Department of Nephrology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
Department of Nephrology, The Lu'an Hospital Affiliated to Anhui Medical University, The Lu'an People's Hospital, Lu'an, Anhui, China.
出版信息
Hippokratia. 2022 Jan-Mar;26(1):19-24.
BACKGROUND
Patients with end-stage renal disease are prone to develop heart failure (HF). The N-terminal pro-brain natriuretic peptide (NT-proBNP, BNP) is regarded as the gold standard for diagnosing HF. However, its prognostic sensitivity in patients with end-stage renal disease is sub-optimal. Soluble suppression of tumorigenesis-2 (sST2) has been well studied in HF but rarely in patients with maintenance hemodialysis (MHD). This study aimed to evaluate the value of sST2 in predicting HF in MHD patients.
METHODS
Twenty-three patients with New York Heart Association (NYHA) class III-IV were included in the HF group and 88 NYHA class I-II patients in the non-heart failure (NHF) group. sST2 and laboratory indexes were compared between the two groups.
RESULTS
The HF group, compared with the NHF group, presented with higher sST2, more advanced age, higher incidence of coronary heart disease (CHD), left ventricle end-diastolic diameter (LVEDD), and pulmonary artery pressure (PAP), and unchanged parathyroid hormone (iPTH). The HF group also had lower ejection fraction (EF), uric acid, inorganic phosphorus, 25-OH VitD3, and serum albumin. Multivariate logistic regression indicated that age, BNP, and sST2 were independent risk factors of HF in MHD patients. Spearman analysis defined that sST2 was positively correlated with PAP (r =0.283, p =0.003) and C-reactive protein (r =0.354, p <0.001); and negatively correlated with sex (r =-0.255, p =0.007), albumin (r =-0.366, p <0.001), uric acid (r =-0.213, p =0.025), 25-OH VitD3 (r =-0.216, p =0.04), calcium (r =-0.219, p =0.021), and inorganic phosphorus (r =-0.256, p =0.007). Receiver operating characteristic curve analysis determined a positive association between BNP and sST2 (r =0.373, p <0.001), with the area under the curve (AUC) of BNP being 0.822 (sensitivity: 0.783, specificity: 0.830) and the AUC of sST2 being 0.841 (sensitivity: 0.913, specificity: 0.761). The AUC of sST2 was 0.841, and the cut-value was 42.840 (sensitivity: 0.913, specificity: 0.761).
CONCLUSION
sST2 can predict HF in MHD patients and facilitate early diagnosis and prevention of HF in MHD patients. HIPPOKRATIA 2022, 26 (1):19-24.
背景
终末期肾病患者易发生心力衰竭（HF）。N 末端脑钠肽前体（NT-proBNP，BNP）被视为诊断 HF 的金标准。然而，其在终末期肾病患者中的预后敏感性并不理想。可溶性肿瘤发生抑制因子 2（sST2）在 HF 方面已得到充分研究，但在维持性血液透析（MHD）患者中研究较少。本研究旨在评估 sST2 在预测 MHD 患者 HF 中的价值。
方法
HF 组纳入 23 例纽约心脏协会（NYHA）心功能 III-IV 级患者，非心力衰竭（NHF）组纳入 88 例 NYHA 心功能 I-II 级患者。比较两组的 sST2 和实验室指标。
结果
与 NHF 组相比，HF 组 sST2 更高、年龄更大、冠心病（CHD）发病率更高、左心室舒张末期内径（LVEDD）和肺动脉压（PAP）更高，甲状旁腺激素（iPTH）无变化。HF 组的射血分数（EF）、尿酸、无机磷、25-羟基维生素 D3（25-OH VitD3）和血清白蛋白也更低。多因素逻辑回归表明，年龄、BNP 和 sST2 是 MHD 患者 HF 的独立危险因素。Spearman 分析表明，sST2 与 PAP（r = 0.283，p = 0.003）和 C 反应蛋白（r = 0.354，p < 0.001）呈正相关；与性别（r = -0.255，p = 0.007）、白蛋白（r = -0.366，p < 0.001）、尿酸（r = -0.213，p = 0.025）、25-OH VitD3（r = -0.216，p = 0.04）、钙（r = -0.219，p = 0.021）和无机磷（r = -0.256，p = 0.007）呈负相关。受试者工作特征曲线分析确定 BNP 和 sST2 之间存在正相关（r = 0.373，p < 0.001），BNP 的曲线下面积（AUC）为 0.822（敏感性：0.783，特异性：0.830），sST2 的 AUC 为 0.841（敏感性：0.913，特异性：0.761）。sST2 的 AUC 为 0.841，截断值为 42.840（敏感性：0.913，特异性：0.761）。
结论
sST2 可预测 MHD 患者的 HF，并有助于 MHD 患者 HF 的早期诊断和预防。《希波克拉底》2022 年，26（1）：19 - 24。
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