| Objective(s):Analyze whether serum soluble tumor suppressor factor 2(soluble ST2,sST2)levels in patients with heart failure(HF)can be used as a new independent indicator for the diagnosis of HF,and explore the combination of sST2 and traditional HF marker N-terminal brain natriuretic peptide Whether the precursor(N-terminal pro-brain natriuretic peptide,NT-proBNP)test has predictive value for the diagnosis of HF,and further explore whether there are potential indicators that supplement the diagnosis of HF in the blood routine,biochemical tests and other indicators.The extensive application of the new biomarker sST2 has accumulated valuable clinical experience.Methods:The 306 HF patients diagnosed in the Department of Cardiology,the Sixth Affiliated Hospital of Kunming Medical University from August 2019 to April 2020 were selected as the HF control group,including 188 males and 118 females,aged 20-94 years,with an average age(69±14)years old.According to the New York Heart Association(NYHA)cardiac function classification,HF patients are divided into cardiac function class Ⅱ group,cardiac function class Ⅱ group,and cardiac function class Ⅳ group.The specific groups are as follows:cardiac function class Ⅱ group consists of 122 cases,including 77 males and 45 females,aged 30-94 years old,with an average age of(69±13)years;64 cases in the cardiac function group Ⅲ,including 36 males and 28 females,aged 31-90 years old,The average age is(68±16)years;there are 120 cases in the heart function group Ⅳ,including 75 males and 45 females,aged 20-90 years old,and the average age(71±13)years old.In addition,according to the 2016 European Society of Cardiology(ESC)heart failure guidelines classification criteria,HF patients were divided into HFrEF heart failure with reduced ejection fraction(Heart failure with reduced ejection fraction,HFrEF)group,ejection fraction Heart failure with mid-range ejection fraction(HFmrEF)group,heart failure with preserved ejection fraction(HFpEF)group,the specific groups are as follows:There are 91 cases in the HFrEF group,of which 55 are male Cases,36 females,aged 40-90 years,average age(71±12)years;HFmrEF group,154 cases,including 102 males and 52 females,aged 20-94 years,average age(70±14)years There are 61 cases in the HFpEF group,including 31 males and 30 females,aged 31-90 years old,with an average age of(66±15)years old.At the same time,a total of 150 cases of healthy physical examination during the same period were selected as the normal control group,including 93 males and 57 females,aged 40-87 years old,with an average age of(67±12)years.Collect and sort out general clinical data and laboratory test data(including blood routine and biochemical indicators)of the HF case group and the normal control group.In addition to the above data,the HF case group also collects cardiac ultrasound data(including the left atrial diameter(left)atrium dimensior,LAD),left ventricular ejection fraction(left ventricular ejection fraction,LVEF),and left ventricular end diastolic diameter(left ventricular end diastolic diameter,LVEDD)).Among them,NT-proBNP and sST2 were detected by electrochemiluminescence and enzyme-linked immunosorbent assay(ELISA)respectively.Analyze the level changes and statistical significance of the above data between the HF group and the control group;analyze the level differences between the above data between the different cardiac function classes and the different left ventricular ejection fraction groups and the differences in the pairwise comparison of each group;analyze the correlation between sST2 and NT-proBNP and the index after screening in the groups of patients with different cardiac function classifications and different ejection fraction groups;After the screening is judged by using the receiver operating characteristic curve(ROC)curve The diagnostic value of HF after the combination of indicators,sST2,NT-proBNP,and sST2 and NT-proBNP.The data was statistically analyzed with SPSS26.0 version software,and the difference was considered statistically significant with a P value of<0.05.Results:1)There was no statistically significant difference between the HF group and the normal control group in terms of gender composition ratio(P>0.05),and the difference between the HF group and the normal control group in terms of age was statistically significant(P<0.05).In terms of blood routine testing indicators,neutrophil ratio(NEUT%),monocyte ratio(MONO%),basophil ratio(BASO%),NEUT,MONO,BASO,average red blood cell volume(MCV),mean hemoglobin(MCH),standard deviation of red blood cell distribution width(RDW-SD),coefficient of variation of red blood cell distribution width(RDW-CV),mean platelet volume(MPV),and large platelet ratio(P-LCR%)Greater than the control group,the difference between the two groups was statistically significant(P<0.05).The ratio of lymphocytes(LYMPH%),eosinophil ratio(EO%),LYMPH,platelets(PLT),red blood cells(RBC),Hemoglobin(HGB),hematocrit(HCT),mean hemoglobin concentration(MCHC)and platelet packed volume(PCT)were all lower than those of the control group,and the difference between the two groups was statistically significant(P<0.05).The white blood cell(WBC)of the HF group),EO and platelet distribution width(PDW)compared with the control group,there was no statistically significant difference between the two groups of data(P>0.05).2)In terms of biochemical indicators,NT-proBNP and sST2,total bilirubin(TBIL),indirect bilirubin(IBIL),aspartate aminotransferase(AST),urea(UREA),creatinine(CREA),uric acid(UA),cystatin(Cysc),lipoprotein a(LPa),creatine kinase-MB subtype(CK-MB),myoglobin(Mb),homocysteine(Hcy),NT-proBNP and sST2 were larger than the normal control group,and the difference between the two groups was statistically significant(P<0.05).Total protein(TP),albumin(ALB),albumin/globulin(A/G),alanine aminotransferase(ALT),total cholesterol(CHOL),triglyceride(TG),high Density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),very low density lipoprotein cholesterol(VLDL-C),apolipoprotein A1(ApoA1),apolipoprotein B(ApoB)and muscle Acid kinase(CK)was smaller than the normal control group,and the difference between the two groups was statistically significant(P<0.05).However,there was no statistically significant difference between the two groups for direct bilirubin(DBIL)and globulin(GLO)(P>0.05).3)Comparing the basic clinical data,blood routine indexes,biochemical indexes and sST2,NT-proBNP levels of HF patients with NYHA Ⅱ,Ⅲ,and Ⅳ cardiac function classification,it was found that with the increase of cardiac function classification,LAD,RDW-SD,RDW-The levels of CV,CysC,NT-proBNP and sST2 continued to increase,and the difference was statistically significant(P<0.05).Comparing heart function class Ⅱ patients with class Ⅲ patients,heart function classⅢ patients with class Ⅳ patients,and heart function class Ⅱ patients with class Ⅳpatients,LAD,RDW-SD,RDW-CV,CysC,NT-proBNP And the difference in sST2 was statistically significant(P<0.05).4)Compare the basic clinical data,blood routine indicators and biochemical indicator levels of HF patients with different ejection fractions.Among the three groups of patients in the HFrEF group,HFmrEF group and HFpEF group,there is no statistically significant difference in other indicators except for LVEF%.(P>0.05).The levels of NT-proBNP were(3452.00(5435.00)VS 3042.00(6218.00)VS 3263.50(5379.00)),and the levels of sST2 were(45.65(26.61)VS 43.73(30.13)VS 44.32(20.57)).There was no statistical difference.Academic significance(P>0.05).5)In the NYHA cardiac function classification group,sST2 was positively correlated with NT-proBNP(r=0.459,P<0.001),sST2 was positively correlated with LAD(r=0.365,P<0.001),and sST2 was positively correlated with RDW-SD(R=-0.242,P<0.001),sST2 is positively correlated with RDW-CV(r=0.247,P<0.001),sST2 is positively correlated with Cysc(r=0.423,P<0.001),sST2 is positively correlated with NYHA heart The functional classification was positively correlated(r=0.862,P<0.001).6)In different ejection fraction HF groups,sST2 was positively correlated with NT-proBNP(r=0.204,P<0.001),sST2 was not correlated with LAD(r=0.082,P>0.001),and sST2 was not correlated with LVEF.There was correlation(r=-0.083,P>0.001),sST2 was not correlated with LVEDD(r=0.001,P>0.001),sST2 was not correlated with ejection fraction HF grouping(r=0.100,P>0.001)).7)The area under the ROC curve for LAD diagnosis of HF is 0.507.When the optimal threshold(Cut-off value)of LAD is set to 40.50mm,the sensitivity of LAD is 51.3%and the specificity is 54.0%;RDW-SD diagnosis The area under the ROC curve of heart failure is 0.830.When the Cut-off value of RDW-SD is set to 46.05fL,the sensitivity is 80.3%and the specificity is 78.6%;the area under the ROC curve of RDW-CV for diagnosing heart failure is 0.786,when the Cut-off value of RDW-CV is set to 13.35%,the sensitivity is 72.2%,and the specificity is 79.3%;the area under the ROC curve for the diagnosis of heart failure by CysC is 0.782,when the Cut-off value of CysC is set When set at 1.34mg/L,the sensitivity is 64.7%and the specificity is 80.0%.The area under the ROC curve of serum sST2 for diagnosing heart failure is 0.851.When the Cut-off value of sST2 is set to 29.03 ng/mL,the sensitivity of sST2 is 87.5%and the specificity is 80.0%;NT-proBNP is the ROC for diagnosing heart failure.The area under the curve is 0.906,When the Cut-off value of NT-proBNP is set to 311.07 pg/mL,the sensitivity is 92.7%and the specificity is 93.6%;when sST2 is combined with NT-proBNP,it can be significantly improved For the diagnostic value of heart failure,the area under the ROC curve is 0.952,the sensitivity is 94.8%,and the specificity is 95.5%.Conclusion(s):1)Serum sST2 and NT-proBNP can assess the severity of HF patients,but cannot effectively distinguish between HFrEF,HFmrEF and HFpEF patients;both can be used as independent indicators for the diagnosis of HF,and the combination can significantly improve the diagnostic efficiency;2)The patient’s LAD,RDW-SD,RDW-CV and CysC levels can assess the severity of HF patients,but cannot effectively distinguish HFrEF,HFmrEF and HFpEF patients;it can be used as an independent indicator to diagnose HF,unlike sST2 and NT-proBNP The combination can further improve the diagnostic efficiency. |
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