• •中国循证心血管医学杂志2019年1月第11卷第1期 Chin J Evid Based Cardiovasc Med,January,2019,Vol.11,No.1• 论著 •急性心力衰竭患者sST2、NT-proBNP的水平变化及临床意义高明1，李琳2，崔维3基金项目：河南省医学教育研究项目(Wjlx2017230)作者单位：1 450008 郑州,河南中医药大学第三附属医院急诊科;2 450008 郑州,河南省人民医院急诊医学部;3 450008 郑州,河南中医药大学第三附属医院心血管科通讯作者：高明,E-mail: gaochangli511@sina.com doi：10.3969/j.issn.1674-4055.2019.01.10【摘要】目的 分析急性心力衰竭患者血清可溶性ST2受体（sST2）、N-末端脑利钠肽前体（NT-proBNP）水平及其临床意义。方法 连续入选2016年9月至2017年3月于河南中医药大学第三附属医院收治的急性心力衰竭患者93例，根据纽约心脏学会（NYHA）分级将其分为NYHA Ⅱ级（n =41）、NYHA Ⅲ级（n =28）、NYHA Ⅳ级（n =24），并于同期随机选取40例健康体检者为对照组。采用酶联免疫吸附法测定各组入院时血清sST2、NT-proBNP水平；采用受试者工作曲线（ROC）曲线下面积（AUC）评估sST2、NT-proBNP对急性心力衰竭诊断价值；记录心力衰竭患者出院后1年时间内心血管不良事件的发生情况。结果 急性心力衰竭患者血清sST2、NT-proBNP水平高于对照组，并随着NYHA分级越高，血清sST2、NT-proBNP水平越高，差异有统计学意义（P ＜0.05）。血清NT-proBNP的AUC为0.807（95%CI ：0.723~0.891，P ＜0.05），血清sST2的AUC为0.781（95%CI ：0.694~0.869，P ＜0.05）。将NT-proBNP、sST2水平分别以中位数分组，比较两组的心血管不良事件发生率，NT-proBNP水平高于中位数组的心血管不良事件发生率高于低水平组（36.54% vs . 14.63%，P ＜0.05），sST2水平高于中位数组的心血管不良事件发生率高于低水平组（28.57% vs . 11.36%，P ＜0.05）。结论 血清sST2、NT-proBNP参与急性心力衰竭发生、发展过程，早期检测可作为预测急性心力衰竭预后的生物学标志物。【关键词】急性心力衰竭；可溶性ST2受体；N-末端脑利钠肽前体；预后【中图分类号】R541.61【文献标志码】A 开放科学（源服务）标识码（OSID）Changes of sST2 and NT-proBNP levels in patient with acute heart failure and its clinical significance Gao Ming *, Li Lin, Cui Wei. *Department of emergency medicine, Third Affiliated Hospital of Henan University of traditional Chinese medicine, Zhengzhou, Henan 450008, ChinaCorresponding author: Gao Ming, E-mail: gaochangli511@sina.com[Abstract ] Objective To explore the changes of serum soluble ST2 receptor (sST2) and N-terminal brainnatriuretic peptide (NT-proBNP) in patients with acute heart failure and its clinical significance. Methods A total of 93 patients with acute heart failure admitted to the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine from September 2016 to March 2017 were included in the NYHA class Ⅱ (n =41), NYHA according to the New York Heart Association (NYHA) classification. Grade Ⅲ (n =28) and NYHA grade Ⅳ (n =24), and 40 healthy subjects were randomly selected as the control group. Serum sST2 and NT-proBNP levels were measured by enzyme-linked immunosorbent assay (ELISA). The area under the receiver operating curve (ROC) curve (AUC) was used to evaluate the diagnostic value of sST2 and NT-proBNP for acute heart failure. Heart failure was recorded. The incidence of cardiovascular adverse events within 1 year after discharge from the patient. Results The serum levels of sST2 and NT-proBNP in patients with acute heart failure were higher than those in the control group, and the higher the NYHA classification, the higher the serum sST2 and NT-proBNP levels, the difference was statistically significant (P <0.05). The AUC of serum NT-proBNP was 0.807 (95%CI : 0.723~0.891, P <0.05), and the AUC of serum sST2 was 0.781 (95%CI : 0.694~0.869, P <0.05). The NT-proBNP and sST2 levels were grouped by median. The incidence of cardiovascular adverse events was compared between the two groups. The incidence of cardiovascular adverse events was higher in the NT-proBNP than in the median array (36.54% vs . 14.63%, P <0.05), the incidence of cardiovascular adverse events was higher in the sST2 level than in the median array than in the low level group (28.57% vs. 11.36%, P <0.05). Conclusion Serum sST2 and NT-proBNP are involved in the development and progression of acute heart failure, and early detection can be used as a biomarker for predicting the prognosis of acute heart failure.[Key words ] Acute heart failure; Soluble ST2 receptor; N-terminal brain natriuretic peptide; Clinicalsignificance急性心力衰竭是临床内科常见的急症，是指心脏收缩或者舒张功能出现障碍，导致心脏排出量不足、静脉血液淤积、动脉血液灌注不足等所致的心脏循环障碍[1]。急性心力衰竭发病率高、病死率高，严重威胁患者的健康和生命质量。早

急性心力衰竭患者sST2、NTproBNP的水平变化及临床意义