广西医学

目的探讨慢性肾功能衰竭合并心力衰竭患者血清生长刺激表达基因2蛋白（ST2）和氨基末端脑钠肽前体（NT⁃proBNP）的水平及其临床意义。方法选取40例慢性肾功能衰竭合并心力衰竭患者（肾衰合并心衰组）、40例单纯心力衰竭患者（单纯心衰组）和40例健康体检者（对照组）作为研究对象，比较3组研究对象肝功能指标（ALT、AST）水平、血脂指标（甘油三酯、总胆固醇、LDL）水平、肾功能指标（血清尿素氮、血清肌酐）水平、心力衰竭患者的纽约心脏病协会（NYHA）分级，以及血清ST2、NT⁃proBNP水平，分析血清ST2、NT⁃proBNP水平与心功能分级、心室指数［左心室舒张末期内径（LVEDD）、左心室射血分数（LVEF）］的相关性，绘制受试者工作特征曲线分析血清ST2、NT⁃proBNP水平诊断心力衰竭的效能。结果肾衰合并心衰组的甘油三酯水平高于对照组，血清尿素氮、血清肌酐水平高于单纯心衰组和对照组（P<0.05）。肾衰合并心衰组和单纯心衰组的血清ST2、NT⁃proBNP水平高于对照组（P<0.05）；肾衰合并心衰组的血清NT⁃proBNP水平、LVEF高于单纯心衰组（P<0.05）。单纯心衰组中NYHA分级Ⅲ~Ⅳ级患者的血清ST2、NT⁃proBNP水平高于Ⅰ~Ⅱ级患者，肾衰合并心衰组中NYHA分级Ⅲ~Ⅳ级患者的血清ST2水平高于Ⅰ~Ⅱ级患者（P<0.05）。单纯心衰组血清ST2、NT⁃proBNP水平与LVEDD呈正相关、与LVEF呈负相关，肾衰合并心衰组血清ST2水平与LVEDD呈正相关、与LVEF呈负相关（P<0.05），而血清NT⁃proBNP水平与LVEDD、LVEF无相关性（P>0.05）。受试者工作特征曲线分析结果显示，在肾衰合并心衰组和单纯心衰组中，血清ST2和NT⁃proBNP水平诊断心力衰竭的效能良好，且具有较高的特异性和灵敏性，但血清ST2水平在两组中的诊断临界值接近（分别为24.14 ng/mL和27.59 ng/mL），而血清NT⁃proBNP水平在两组中的诊断临界值差异较大（分别为1 795.00 pg/mL和495.00 pg/mL）。结论 NT⁃proBNP和ST2均为反映心功能的血清学指标，但血清ST2水平受肾功能影响较小，稳定性更强，对于慢性肾功能衰竭合并心力衰竭患者，ST2对心力衰竭的诊断价值更高，可联合检测血清ST2与NT⁃proBNP水平以获得更优的诊断效能。

Objective　To explore the levels of serum growth stimulation expressed gene 2 (ST2) and N⁃terminal pro⁃B⁃type natriuretic peptide (NT⁃proBNP) in patients with chronic renal failure and concomitant heart failure and their clinical significance. Methods　A total of 40 patients with chronic renal failure and concomitant heart failure (the renal failure and concomitant heart failure group), 40 patients with simple heart failure (the simple heart failure group), and 40 healthy check⁃up individuals (the control group) were selected as the research subjects. The levels of liver function indices (ALT, AST), blood lipid indices (triglyceride, total cholesterol, LDL) levels, renal function indices (serum urea nitrogen, serum creatinine) levels, New York Heart Association (NYHA) classification of heart failure patients, and levels of serum ST2 and NT⁃proBNP were compared between research subjects of the three groups. The correlation of serum ST2 and NT⁃proBNP levels with cardiac function classification and ventricle mass index (left ventricular end diastolic dimension [LVEDD], left ventricular ejection fraction [LVEF]) was analyzed. The efficiency of serum ST2 and NT⁃proBNP levels for diagnosing heart failure was analyzed by drawing the receiver operating characteristic curve. Results　The renal failure and concomitant heart failure group exhibited a higher level of triglyceride as compared with the control group, and higher levels of serum urea nitrogen and creatinine as compared with the simple heart failure group and the control group (P<0.05). The renal failure group and concomitant heart failure group and the simple heart failure group interpreted higher serum ST2 and NT⁃proBNP levels as compared with the control group (P<0.05), and the renal failure and concomitant heart failure group yielded higher serum NT⁃proBNP level and LVEF as compared with the simple heart failure group (P<0.05). Patients with NYHA classification in Ⅲ-Ⅳ of the simple heart failure group obtained higher levels of serum ST2 and NT⁃proBNP as compared with patients in Ⅰ-Ⅱ, while patients with NYHA classification in Ⅲ-Ⅳ of the renal failure and concomitant heart failure group expressed a higher serum ST2 level as compared with patients in Ⅰ-Ⅱ (P<0.05). Serum ST2 and NT⁃proBNP levels positively correlated with LVEDD, whereas negatively correlated with LVEF in the simple heart failure group; furthermore, serum ST2 level positively correlated with LVEDD, whereas negatively correlated with LVEF in the renal failure and concomitant heart failure group (P<0.05), while serum NT⁃proBNP level exerted no correlation with LVEDD and LVEF (P>0.05). The results of receiver operating characteristic curve analysis revealed that in the renal failure and concomitant heart failure group and the simple heart failure group, the efficiency of serum ST2 and NT⁃proBNP level for diagnosing heart failure was favorable, exerting favorably high specificity and sensitivity; however, the diagnostic critical values of serum ST2 level were similar in the two groups (24.14 ng/mL and 27.59 ng/mL, respectively), whereas the diagnostic critical values of serum NT⁃proBNP level were great different in the two groups (1 795.00 pg/mL and 495.00 pg/mL, respectively). Conclusion Both NT⁃proBNP and ST2 are serological indices reflecting cardiac function, but serum ST2 level is less affected by renal function and has stronger stability. For patients with chronic renal failure and concomitant heart failure, ST2 exerts a higher diagnostic value for heart failure, and serum ST2 and NT⁃proBNP levels detection can be combined to obtain superior diagnostic efficiency.

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