摘要
目的观察重症心力衰竭患者血清可溶性生长刺激表达基因2蛋白(soluble suppression of tumorigenicity 2, sST2)水平及中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio, NLR)、单核细胞与高密度脂蛋白胆固醇比值(monocyte to high-density lipoprotein cholesterol ratio, MHR)变化,探讨其与重症心力衰竭患者预后的关系。方法 85例重症心力衰竭患者均给予规范治疗,病情缓解出院后随访6个月,67例生存者为生存组,18例死亡者为死亡组。比较2组性别、年龄、心率、血压等指标以及入院24 h内白细胞计数、中性粒细胞计数、淋巴细胞计数、单核细胞计数及血清三酰甘油、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、肌酐水平;比较2组入院24 h内及出院前1 d血清N末端脑钠肽前体(N-terminal-probrain natriuretic peptide, NT-proBNP)、sST2水平及NLR、MHR、左室射血分数(left ventricular ejection fraction, LVEF);Pearson相关法分析重症心力衰竭患者入院24 h内血清sST2水平及NLR、MHR与血清NT-proBNP水平、LVEF的相关性;绘制ROC曲线,评估血清sST2及NLR、MHR预测重症心力衰竭患者死亡的价值。结果死亡组心率快于生存组(P<0.05),白细胞计数、中性粒细胞计数、单核细胞计数、血肌酐水平均高于生存组(P<0.05),淋巴细胞计数、高密度脂蛋白胆固醇水平均低于生存组(P<0.05),女性比率、年龄、体质量、合并基础疾病比率、入院24 h内收缩压及血清三酰甘油、总胆固醇、低密度脂蛋白胆固醇水平与生存组比较差异均无统计学意义(P>0.05)。入院24 h内及出院前1 d,死亡组NLR(8.67±1.12、8.11±1.06)、MHR(0.96±0.04、0.89±0.03)及血清sST2[(68.42±8.47)、(66.75±7.06)μg/L]、NT-proBNP[(9 809.01±864.52)、(9 517.35±364.85)μg/L]水平均高于生存组[NLR(5.52±1.37)、(4.12±0.98),MHR(0.78±0.02)、(0.62±0.01),sST2(62.63±6.96)、(57.82±4.19)μg/L,NT-proBNP(9 259.83±585.68)、(4 975.26±322.47)μg/L](P<0.05),LVEF[(31.01±1.86)%、(30.65±1.64)%]低于生存组[(35.17±2.04)%、(37.58±1.72)%](P<0.05);生存组出院前1 d血清NT-proBNP、sST2水平及NLR、MHR均低于入院24 h内(P<0.05),死亡组出院前1 d血清NT-proBNP、sST2水平及NLR、MHR与入院24 h内比较差异均无统计学意义(P>0.05)。重症心力衰竭患者血清sST2水平及NLR、MHR与LVEF均呈负相关(r=-0.837,P=0.010;r=-0.826,P=0.011;r=-0.807,P=0.015),与血清NT-proBNP水平均呈正相关(r=0.893,P=0.002;r=0.786,P=0.021;r=0.879,P=0.004)。血清sST2及NLR、MHR分别以59.5μg/L、5.585、0.760为最佳截断值,单独及联合预测重症心力衰竭患者死亡的AUC分别为0.781(95%CI:0.652~0.910,P=0.016)、0.853(95%CI:0.741~0.965,P=0.027)、0.806(95%CI:0.680~0.933,P=0.015)、0.864(95%CI:0.756~0.973,P=0.001),灵敏度分别为74.2%、82.3%、80.6%、84.2%,特异度分别为64.5%、71.0%、67.7%、73.7%。结论重症心力衰竭患者NLR、MHR及血清sST2水平增高,提示短期死亡风险增高,三者联合检测对重症心力衰竭患者短期死亡预测价值更高。
Objective To observe the changes of soluble suppression of tumorigenicity 2(sST2), neutrotrophil to lymphocyte ratio(NLR), and monocyte to high-density lipoprotein cholesterol ratio(MHR) in patients with severe heart failure, and to investigate their correlations with the prognosis of patients with severe heart failure. Methods All 85 patients with severe heart failure were given standardized treatment, and were followed up for 6 months after remission and discharge, in which 67 patients survived(survival group) and 18 died(death group). The gender, age, heart rate, blood pressure, neutrophil count, lymphocyte count, monocyte count, and serum levels of triacylglycerol, total cholesterol, low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C) and creatinine in 24 h after admisson were detected and compared between two groups. The levels of serum N-terminal-probrain natriuretic peptide(NT-proBNP) and sST2, NLR, MHR, and left ventricular ejection fraction(LVEF) were compared in 24 h after admission and 1 day before discharge between two groups. Pearson correlation analysis was done to study the correlations of sST2,NLR and MHR with NT-proBNP and LVEF in patients with severe heart failure in 24 hafter admission.ROC curve was drawn to assess the values of sST2,NLR and MHR to the prediction of death in patients with severe heart failure.Results Compared with survival group,the heart rate was faster(P<0.05),the leukocyte count,neutrophil count,monocyte count and serum creatinine level were higher(P<0.05),and the lymphocyte count and HDL-C level were lower in death group(P<0.05).There were no significant differences in the age,percentage of female patients,body mass,percentage of patients with underlying diseases,systolic blood pressure,and levels of serum triacylglycerol,total cholesterol and LDL-C in 24 hafter admission between two groups(P>0.05).The values of NLR,MHR,sST2 and NT-proBNP were higher in death group [8.67±1.12,8.11±1.06;0.96±0.04,0.89±0.03;(68.40±8.47),(66.75±7.06)μg/L;(9 809.01±864.52)%,(9 517.35±364.85)μg/L]than those in survival group[5.52±1.37,4.12±0.98;0.78±0.02,0.62±0.01;(62.63±6.96),(57.82±4.19)μg/L;(9 259.83±585.68),(4 975.26±322.47)μg/L](P<0.05),and LVEFs[(31.01±1.86)%,(30.65±1.64)%]were lower than those in survival group[(35.17±2.04)%,(37.58±1.72)%]in 24 hafter admission and 1 day before discharge(P<0.05).The serum levels of serum NT-proBNP and sST2,NLR and MHR were all higher in 24 hafter admission than those 1 day before discharge in survival group(P<0.05),and showed no significant differences in death group(P>0.05).sST2,NLR and MHR were negatively correlated with LVEF(r=-0.837,P=0.010;r=-0.826,P=0.011,r=-0.807,P=0.015),and were positively correlated with NT-proBNP(r=0.893,P=0.002;r=0.786,P=0.021;r=0.879,P=0.004).When the optimal cut-offvalues of serum sST2,NLR and MHR were 59.5μg/L,5.585 and 0.760,the AUCs of single and combined detection for predicting death in patients with severe heart failure were 0.781(95%CI:0.652-0.910,P=0.016),0.853(95%CI:0.741-0.965,P=0.027),0.806(95%CI:0.680-0.933,P=0.015),and 0.864(95%CI:0.756-0.973,P=0.001),the sensitivities were 74.2%,82.3%,80.6%and 84.2%,and the specificities were 64.5%,71.0%,67.7% and 73.7%,respectively.Conclusion NLR,MHR and serum ST2 are elevated in 24 hafter admission in patients with severe heart failure,indicating a high risk of short-term death,and the combined detection of them three has a predictive value.
作者
李娜
张羽
齐晓瑜
李敬
LI Na;ZHANG Yu;QI Xiao-yu;LI Jing(Department of Cardiology,Hengshui People's Hospital,Hengshui,Hebei 053000,China)
出处
《中华实用诊断与治疗杂志》
2022年第3期259-262,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
河北省医学科学研究重点课题(20191767)。
