可溶性人基质裂解素对急性失代偿心力衰竭伴肾功能不全病人预后的预测价值马超,徐晓东，方中，陶成敏(安徽医科大学池州临床学院心内科，安徽池州247000)摘要：目的探讨可溶性人基质裂解素(sST2)对急性失代偿心力衰竭(ADHF)伴肾功能不全病人预后的预测价值。方法选取住院的ADHF病人94例。检测N味端脑钠肽前体(NT-proBNP)、sST2水平。根据估算肾小球滤过率(eGFR)，将病人分为两组，A组(eGFR<60mL-min，・1.73m")42例,B组(eGFR^60mL-min_1-1.73nr2)52例。随访时间为6个月，记录出院后发生因心衰再入院及全因性死亡事件。根据受试者特征(ROC)曲线得到sST2、NT-proBNP预测ADIIF病人短期预后的ROC曲线下面积(AUC)及最佳截断值、灵敏度、特异度，分别比较两者在两组中的AUC。结果sST2与lg(NT-proBNP)呈正相关(r=0.579,P<0.01)osST2水平在两组中差异无统计学意义(户>0.05)。随访6个月后,A组因心衰再入院及全因死亡发生率高于B组(P=0.034)。A组中sST2、NT.proBNP预测病人因心衰再入院及全因死亡AUC分别为0.793(95%C/：0.654〜0.932,002)、0.745(95%C/：0.594~0.896,F=0.008)。结论sST2不受肾功能影响,并且对ADHF伴肾功能不全病人发生因心衰再入院及全因死亡的短期预后有较好预测价值。关键词:可溶性人基质裂解素;N.末端脑钠肽前体；急性失代偿心力衰竭；肾功能不全;预后doi：10.3969/j.issn.1009-6469.2017.07.022PrognosticvalueofsolubleST2intreatingpatientswithacutedecompensatedheartfailureandrenalinsufficiencyMAChao,XUXiaodong,FANGZhong,TAOChengmin(DepartmentofCardiology,ChizhouClinicalCollegeAnhuiMedicalUniversity,ChizhouyAnhui247000,China)Abstract：ObjectiveToexplorethepredictivevalueofsolubleST2(sST2)ontheprognosisofacutedecompensatedheartfailure(ADHF)andrenalinsufficiency.MethodsNinety-fourcasesofADHEwereselected.ThelevelofsSrF2andNT-proBNPweredetec-ted.Accordingtotheestimatedglomerularfiltrationrate(eGFR),thepatientswereassignedinto2groups.Therewere42casesasgroupA(eGFR<60mL・min-1•1.73m~2),and52casesasgroupB(eGFR^60mL・min1•1.73m~2).Thefollow-uptimewas6months.Theeventsoftheoccurrenceofall-causedeathandreadmissionduetoheartfailurewereobserved.Accordingtothere-ceiveroperatorcharacteristic(ROC)curve,theareaundertheROCcurve(AUC)andtheoptinia-1cut-offvalue,sensitivityandspecificityofsST2andNT-proBNPwerecaculatedtopredicttheshorttermprognosisofADIIFpatients.TheAUCofsST2andNT-proBNPinthetwogroupswerecompared.ResultsTherewerepositivecorrelationsbetweensST2andIg(NT-proBNP)(r=0.579,P<0.01).TherewasnosignificantdifferenceinsST2levelbetweenthetwogroups(P>0.05).After6monthsoffollow-up,readmissionofgroupAcluetoheartfailureandall-causemortalityratewashigherthangroupB(P=0.034).IngroupA,theAUCofsST2andNT-proBNPpredictingreadmissionduetoheartfailureandallcausemortalitywere0.793(95%C/：0.654-0.932=0.002),and0.745(95%C/：0.594-0.896,P=0.008),respectively.ConclusionssST2hasbettershort-termpredictivevalueinheartfailurereadmissionandall-causedeathofacutedecompensatedheartfailurepatientswithrenalinsufficiency,anditisnotaffectedbyrenalfunctioncomparedwithNT-proBNPinADHFpatients.Keywords:sST2；NT-proBNP；Acuteheartfailure；Renalinsufficiency；Prognosis通信作者:徐晓东，男，教授，硕士生导师，研究方向：心衰诊断和治疗,E-mail：xiaodongxu@sina.com[10]曲首辉，时春艳，陈倩，等.孕中、晚期孕妇子宫颈长度测量对早产的预测价值[J].中华妇产科杂志,2011,46(10):748-752.[11]李萍，李雪，陈红.超声测量宫颈长度在早产预测中的价值[J].四川医学,2010,31(9)：1368-1369.[12]高虹.胎儿纤维连接蛋白和超声测量宫颈长度联合预测早产的临床研究[J].临床医学,2010,30(8)：75.76.[13]杨慧敏.阴道超声监测宫颈形态在预测早产及诊治中的临床研究[J].按摩...