| Background: Heart failure has become an increasingly serious public health issue,the current clinical diagnosis of which is mainly based on clinical symptom,sign and related laboratory examination.Test of biomarkers is of vital importance to heart failure diagnosis.The most common biomarkers applied to diagnosis are brain natriuretic peptide(BNP)and N-terminal pro-brain natriuretic petide(NT-pro BNP),affected by renal function,whose diagnostic value for heart failure,however,is limited,for those with renal insufficiency and heart failure.Soluble ST2(s ST2),as a new cardiac biomarker,is one of the recommended biomarkers on 2013 ACCF/AHA Guideline for Heart Failure and 2014 Chinese Guideline for Heart Failure Diagnosis and Treatment.As its metabolic way and metabolic pathway in humans remain unclear,and its relations with renal function is still controversial,this thesis will investigate the diagnostic value of s ST2 for renal-insufficient patients in heart failure.Purpose: To determine the serum s ST2 level of heart failure patients with renal insufficienty,analyse its link with left ventricular ejection fraction(LVEF)and NT-pro BNP and discuss its diagnostic value for renal-insufficient patients of varying degrees in heart failure.Method: Select 176 renal-insufficient inpatients in Fujian Provincial Hospital from December of 2016 to March of 2017,among which 122 renal-insufficient patients with heart failure belong to heart-failure group,the rest 54 patients with normal cardiac function as control group.All the selected patients are grouped by estimated glomerular filtration rate(e GFR);Meanwhile,those in heart-failure group are classified into cardiac function II~IV according to functional classification standard of New York Hear Association(NYHA).Group one(e GFR = 89~60ml/min/1.73m2): 61 in total,of which 36 f belong to heart-failure group and 25 in control group.Group two(e GFR = 59~30ml/min/1.73m2):69 in total,of which 50 belong to heart-failure group and 19 in control group.Group three(e GFR <30ml/min/1.73m2): 46 in total,of which 36 belong to heart-failure group and 10 in control group.Selected patients complete checks of plasma NT-pro BNP,serum s ST2 and cardiac color ultrasound based on routine examination after being admitted to hospital.(1)In each group mentioned above,compare plasma NT-pro BNP and serum s ST2 level of patients in heart-failure group and control group;(2)Compare plasma NT-pro BNP and serum s ST2 level of patients in each heart-failure group;(3)Compare plasma NT-pro BNP and serum s ST2 level of patients in each control group;(4)Compare serum s ST2 level of patients with varying grades of cardiac function in each heart-failure group;(5)Analyse the connection between serum s ST2 in each heart-failure group;(6)Through ROC curve,compare the diagnostic value of patients' serum s ST2 and plasma NT-pro BNP in heart failure in each group.Result:(1)In all the three groups,s ST2 level of heart-failure group is significantly higher than its control group counterpart(P<0.05).NT-pro BNP level of hear-failure group in group one and two is apparently higher than that of control group(P<0.05),while in group three,the difference of NT-pro BNP level of heart-failure group and that of control group has no statistics significance(P=0.053).(2)In three heart-failure group,difference of level of s ST2 of patients has no statistics significance(P=0.053).NT-pro BNP level of heart-failure group in group two is much higher than that of heart-failure group(P<0.05)in group one;NT-pro BNP level of heart-failure group in group three greatly exceeds that of heart-failure group in group one and group two(with both P<0.05).(3)Patients' s ST2 level difference in all three control group has no statistics significance(P>0.017);NT-pro BNP level of control group in group two is greatly higher than that of control group in group one(P<0.05);NT-pro BNP level of control group in group three is greatly higher than that of control group in group two and group one(with both P<0.05)(4)s ST2 level and cardiac function of hear-failure patients in each group showed positive correlation(r and p value in three groups are r=0.405,P=0.016;r=0.525,P=0.000;r=0.509,P=0.002 respectively).(5)There is no correlation of s ST2 and LVEF in each heart-failure group(Each group p>0.05).(6)Group one: The area under the curve of s ST2 and NT-pro BNP for heart failure diagnosis is 0.754?0.724;Group two: The area under the curve of s ST2 and NT-pro BNP for heart failure diagnosis is 0.765?0.805;Group three: The area under the curve of s ST2 for heart failure diagnosis is 0.847,While NT-pro BNP have no diagnostic value(p>0.05).Conclusion:(1)Among renal-insufficient patients,serum s ST2 of patients with heart failure is significantly higher than that of those with normal cardiac function;and it shows positive correlation with severity of heart failure.(2)Patients' serum s ST2 level is not affected by their renal function.(3)For heart-failure patients with renal insufficiency,serum s ST2 has no correlation with LVEF.(4)For patients with e GFR >30ml/min/1.73m2,serum s ST2 and plasma NT-pro BNP both have rather high independent diagnostic value;However,for patients e GFR <30ml/min/1.73m2,the diagnostic value of serum s ST2 in heart failure is significantly higher than that of NT-pro BNP. |
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