摘要目的 评价血清可溶性人基质裂解素-2(sST2)浓度变化在老年急性心力衰竭(AHF)患者预后评估中的作用和价值. 方法 前瞻性研究,连续入选北京医院2013年1月至2014年8月确诊为老年AHF患者75例,于入院时和入院后72～96 h分别检测外周血血清ST2水平.并纳入38例健康查体者(其中男18例、女20例,年龄70～80岁)为对照组,所有病例随访1年,记录患者生存情况和或再次因AHF入院. 结果 75例AHF患者中,发生终点不良事件组两次sST2均高于非事件组(P=0.000),发生终点不良事件组动态sST2高于非事件组(P=0.023),发生终点不良事件组动态sST2比值高于非事件组(P=0.033).入院时sST2联合动态sST2的受试者工作特征(ROC)曲线下面积为0.861,大于入院时sST2的ROC曲线下面积0.784(P＜0.001)及动态sST2的ROC曲线下面积0.696(P=0.013);入院时sST2低于1 408 ng/L且动态sST2低于101 ng/L的患者1年终点事件发生率为21.4％(3/14),而入院时sST2高于1 408 ng/L且动态sST2高于101 ng/L的患者1年终点事件发生率为85.7％(12/14). 结论 老年AHF患者sST2水平升高,发生心血管不良事件的AHF患者的sST2水平高于无事件发生者,动态sST2变化在事件组和非事件组亦有差异,动态监测sST2可更好地评估AHF患者的预后.

abstractsObjective To investigate the predicting value of serial serum human stromelysin-2 (ST2)testing on prognosis in elderly patients with acute heart failure(AHF).Methods 75 AHF patients aged 60 to 90 were selected in our study who were in Beijing Hospital during 2013.1 ～ 2014.8,blood sampling of serum ST2 took place at admission and 72-96 h later.Moreover,38 healthy people aged 70 to 80 were chosen as control group.Follow-up was performed 1 year after acute attack.We defined the end of observation as recurrence of heart failure or any cause of death.The data was analyzed by SPSS19.0.Results Among 55 AHF patients,sST2 level was higher in patients with endpoint events than those without it on the two moment(P=0.000).And we found that the change in sST2 was higher in patients with endpoint events than those without it(P=0.023);and the percentage change in sST2 was also significantly different(P=0.033).Receiver operator curve analysis of the change in sST2 from baseline to 72-96 h later was strongly reflective of prognosis with area under the curve(AUC) of 0.696(P=0.013).And the change in sST2 Combined with the sST2 level at admission to predict the prognosis of AHF,the result would be more exciting,the area under the receiver operating characteristic (ROC) curve is 0.861 (P ＜ 0.001).The endpoint event rate of the patients whose level of sST2 at admission was below 1408 ng/L and the change level in sST2 below 101 ng/L was 21.4％(3/14),while the data in patients whose level of sST2 at admission is above 1 408 ng/L and the change level in sST2 above 100 ng/L was 85.7％(12/14).Conclusions in elderly patients of AHF,sST2 elevate markedly.The result shows that the level of sST2 may be used to evaluate AHF prognosis.And the change in sST2 are able to predict the prognosis of AHF.Compared with NT-proBNP,serial sST2 testing appears to be a promising candidate for monitoring these patients.