摘要
目的 探讨血清可溶性生长刺激表达基因2蛋白(sST2)、生长分化因子-15(GDF-15)、卵泡抑素样蛋白1(FSTL1)联合对心力衰竭(心衰)患者诊断的临床价值.方法 纳入沧州市人民医院2022年1月～2023年12月接收的心衰患者145例作为心衰组,另选择同时期来本院体检的无心衰健康者145例作为对照组;依据纽约心脏病协会(NYHA)心功能分级将心衰组分为NYHA Ⅱ级(48例)、NYHA Ⅲ级(76例)和NYHA Ⅳ级(21例);Pearson相关分析血清sST2、GDF-15、FSTL1水平的相关性;多元logistic回归分析筛选影响心衰发生的因素;血清sST2、GDF-15、FSTL 1联合诊断心衰的曲线下面积(AUC)通过绘制受试者工作特征(ROC)曲线获得,并用Z检验进行验证.结果 心衰组血清sST2、GDF-15、FSTL1、N末端B型利钠肽原(NT-proBNP)水平显著高于对照组[(43.76±13.93)ng/ml 比(32.48±10.25)ng/ml、(964.37±312.25)ng/L 比(752.80±243.67)ng/L、(568.11±174.89)ng/L 比(436.64±138.33)ng/L、(1627.04±476.53)pg/ml 比(217.49±69.14)pg/ml,P＜0.05].NYHA Ⅳ级、NYHA Ⅲ级血清sST2、GDF-15、FSTL1 水平显著高于NYHA Ⅱ 级(t=7.854,6.432,7.100,35.249,P＜0.05),NYHA Ⅳ级血清 sST2、GDF-15、FSTL1 水平显著高于NYHA Ⅲ级(P＜0.05).心衰组血清 sST2 与 GDF-15、FSTL1 水平呈正相关(r=0.502、0.508,P＜0.001),血清 GDF-15 与 FSTL1水平呈正相关(r=0.444,P＜0.001).影响心衰发生的危险因素有sST2、GDF-15、FSTL1、NT-proBNP(P＜0.05).血清 sST2、GDF-15、FSTL 1 联合诊断心衰的 AUC 为 0.886(95％CI 0.847～0.924),sST2、GDF-15、FSTL1 单独诊断心衰的 AUC 分别为 0.810(95％CI 0.760～0.859)、0.773(95％CI 0.721～0.826)、0.773(95％CI 0.719～0.827),三者联合诊断价值较sST2(Z=2.374,P=0.018)、GDF-15(Z=3.363,P=0.001)、FSTL1(Z=3.363,P=0.001)单独更高.结论 sST2、GDF-15、FSTL1在心衰患者血清中异常升高表达,三者与患者心功能分级密切相关,联合可提高心衰诊断价值.
Abstract
Objective To explore the clinical value of combining test of serum soluble growth stimulation expressed gene 2(sST2),growth differentiation factor-15(GDF-15),and follistatin-like protein 1(FSTL1)in the diagnosis of heart failure patients.Methods A total of 145 heart failure patients admitted to Cangzhou People's Hospital from January 2022 to December 2023 were included as the heart failure group,another 145 volunteers without heart failure who came to our hospital for physical examinations were selected as the reference group.According to the New York Heart Association(NYHA)cardiac function classification,heart failure was separated into NYHA grade Ⅱ(48 cases),NYHA grade Ⅲ(76 cases),and NYHA grade Ⅳ(21 cases).Pearson correlation was applied to analyze the correlation between serum sST2,GDF-15,and FSTL1 levels.Multiple logistic regression analysis(stepforward method)was applied to screen for the factors that affected the occurrence of heart failure.The area under the curve(AUC)for the diagnosis of heart failure with the combination of serum sST2,GDF-15,and FSTL1 was obtained by plotting the receiver operating characteristic(ROC)curve and validated using Z-test.Results The serum levels of sST2,GDF-15,FSTL1 and N-terminal pro-B-type natriuretic peptide(NT-proBNP)in the heart failure grou were greatly higher than those in the reference group[(43.76±13.93)ng/ml vs.(32.48±10.25)ng/ml、(964.37±312.25)ng/L vs.(752.80±243.67)ng/L、(568.11±174.89)ng/L vs.(436.64±138.33)ng/L、(1627.04±476.53)pg/ml vs.(217.49±69.14)pg/ml,P＜0.05].The serum levels of sST2,GDF-15 and FSTL1 in NYHA grade Ⅳ and NYHA grade Ⅲ were greatly higher than those in NYHA grade Ⅱ(t=7.854,6.432,7.100,35.249,P＜0.05),while the serum levels of sST2,GDF-15,and FSTL1 in NYHA grade Ⅳ were greatly higher than those in NYHA grade Ⅲ(P＜0.05).The serum sST2 level was positively correlated with GDF-15 and FSTL1 levels in the heart failure group(r=0.502,0.508,P＜0.001),while the serum GDF-15 level was positively correlated with FSTL1 level(r=0.444,P＜0.001).The risk factors affecting heart failure included sST2,GDF-15,FSTL1 and NT-proBNP(P＜0.05).The AUC for combined diagnosis of heart failure with serum sST2,GDF-15 and FSTL1 was 0.886(95％CI 0.847-0.924),while the AUC for single diagnosis of heart failure with sST2,GDF-15 and FSTL1 was 0.810(95％CI 0.760-0.859),0.773(95％CI 0.721-0.826)and 0.773(95％CI 0.719-0.827),respectively;the combined diagnostic value of the three was higher than that of sST2(Z=2.374,P=0.018),GDF-15(Z=3.363,P=0.001)and FSTL1(Z=3.363,P=0.001)alone.Conclusion sST2,GDF-15 and FSTL1 are abnormally upregulated in the serum of patients with heart failure,and they are closely related to the grading of heart function.The combining test of them can improve the diagnostic value of heart failure.
维普
万方数据