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

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，即射血分数保留型的心衰组（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），每组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、保留型的心衰组、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、保留型的心衰组、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之间互相呈正相关关系（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 (Galectin-3), soluble growth stimulator expression 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 each group). Thirty-three healthy patients in our hospital 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 aspects 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-proBNPHR = 1.000, 95%CI = 1.000 ~ 1.001), EF (HR = 1.134, 95%CI) 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 ＜ 0.01 ~ P ＜ 0.05).
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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