Galectin−3、sST2和GDF−15 对不同射血分数心力衰竭病人的预后价值比较

王月祥; 胡擎天; 曾超超; 陈杰; 胡司淦; 耿志军; 李静; 刘进军

doi:10.13898/j.cnki.issn.2097-5252.2026.05.006

Galectin−3、sST2和GDF−15 对不同射血分数心力衰竭病人的预后价值比较

Comparison of the prognostic value of Galectin-3, sST2 and GDF-15 in heart failure patients with different ejection fraction

摘要

摘要:
目的： 探讨半乳糖凝集素−3（Galectin−3）、可溶性生长刺激表达基因2蛋白（sST2）及生长分化因子15（GDF−15）对不同射血分数的心力衰竭病人的诊断价值及预后比较。
方法： 选取慢性心力衰竭病人120例，根据左心室射血分数将心力衰竭病人分为3组，即射血分数保留型心衰组（HFpEF，EF ≥ 50%）、射血分数中间型心衰组（HFmrEF，49% ≥ EF ≥ 41%）、射血分数降低型心衰组（HFrEF，EF ≤ 40%），各40例。选取同期体检健康病人33名为对照组，统计各组入选病人的一般临床资料，采用酶联免疫吸附法（ELISA）测定各组病人血清Galectin−3、sST2和GDF−15的水平。完成6个月随访后，对病人相关参数进行统计学分析。
结果： 对照组与心衰组在射血分数、NT−proBNP、左室舒张末径、sST2、Galectin−3、GDF−15等方面差异均有统计学意义（P ＜ 0.01）。其中射血分数在对照组、保留型心衰组、中间型心衰组、降低型心衰组之间依次降低（P ＜ 0.01），NT−proBNP、左室舒张末径、sST2、Galectin−3、GDF−15等5个指标在对照组、保留型心衰组、中间型心衰组、降低型心衰组之间均呈现依次升高（P ＜ 0.01）。Spearman相关性分析显示，心衰组中sST2、Galectin−3、GDF−15、NT−proBNP、LVDD之间呈正相关关系（P ＜ 0.01），且上述5个指标与射血分数均呈负相关关系（P ＜ 0.01）。不良预后事件ROC曲线显示，HFrEF组和HFmrEF组病人的NT−proBNP指标具有较高的AUC值、灵敏度和特异度，HFpEF病人的GDF−15指标具有较高的AUC值、灵敏度和特异度。多因素COX回归分析显示在不同类型的慢性心衰组在不同类型的心衰组中sST2（HR = 0.976、95%CI = 0.956～0.995）、NT−proBNP（HR = 1.000、95%CI = 1.000～1.001）、EF（HR = 1.134、95%CI = 1.060～1.214）和GDF−15（HR = 1.004、95%CI = 1.001～1.008）均可以作为心衰病人不良预后事件的独立预测因子（P ＜ 0.05～P ＜ 0.01）。
结论： 在不同类型的心衰组中sST2、Galectin−3和GDF−15对心衰病人不良事件的发生均有较高的预测价值。同时sST2、GDF−15和NT−proBNP可作为独立危险因子对病人短期风险事件进行预测评估。

Abstract:
Objective To investigate the diagnostic value and prognosis of Galectin-3, soluble growth stimulation expressed gene 2 protein (sST2) and growth differentiation factor 15 (GDF-15) in heart failure patients with different ejection fractions.
Methods A total of 120 patients with chronic heart failure were selected. According to the left ventricular ejection fraction, the patients with heart failure were divided into three groups: heart failure group with preserved ejection fraction (HFpEF, EF ≥ 50%), heart failure group with intermediate ejection fraction (HFmrEF, 49 ≥ EF ≥ 41), and heart failure group with reduced ejection fraction (HFrEF, EF ≤ 40) ( 40 cases in each group). Thirty-three healthy patients during the same period were selected as the control group. The general clinical data of each group were recorded, and the serum levels of Galectin-3, sST2 and GDF-15 were determined by enzyme-linked immunosorbent assay (ELISA). After 6 months of follow-up, the relevant parameters of patients were statistically analyzed.
Results The differences of the ejection fraction, NT-proBNP, left ventricular end-diastolic diameter, sST2, Galectin-3, GDF-15 and other indicators between control group and heart failure group were statistically significant (P ＜ 0.01). The ejection fraction decreased successively among the control group, reserved group, intermediate group and reduced group (P ＜ 0.01), and the NT-proBNP, left ventricular end-diastolic diameter, sST2, Galectin-3 and GDF-15 increased successively in the control group, reserved heart failure group, intermediate heart failure group and reduced heart failure group (P ＜ 0.01). The results of Spearman correlation analysis showed that the sST2, Galectin-3, GDF-15, NT-proBNP and LVDD in the heart failure group were positively correlated with each other (P ＜ 0.01), and the above five indexes were negatively correlated with ejection fraction (P ＜ 0.01). The results of ROC curve of adverse prognostic events showed that the NT-proBNP index of patients in HFrEF group and HFmrEF group had higher AUC value, sensitivity and specificity, and the GDF-15 index of HFpEF patients had higher AUC value, sensitivity and specificity. The results of multivariate COX regression analysis showed that the sST2 (HR = 0.976, 95%CI = 0.956–0.995), NT-proBNP (HR = 1.000, 95%CI = 1.000–1.001), EF (HR = 1.134, 95%CI = 1.060–1.214) and GDF-15 (HR = 1.004, 95%CI = 1.001–1.008) in different types of chronic heart failure group were the independent predictors of adverse prognostic events in patients with heart failure (P ＜ 0.05 to P ＜ 0.01).
Conclusions The sST2, Galectin-3 and GDF-15 in different types of heart failure groups have high predictive value for the occurrence of adverse events in patients with heart failure. Meanwhile, the sST2, GDF-15 and NT-proBNP can be used as independent risk factors to predict and evaluate short-term risk events in patients.

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