超声联合sST2在鉴别不同类型心力衰竭的价值研究

目的探讨超声联合可溶性生长刺激表达基因2蛋白(sST2)在不同类型心衰中的应用价值方法以2018年7月—2019年10月本院收治的117例疑似心衰患者为研究对象,患者入院后分别在心脏部位进行超声心动图检查,抽取肘静脉血并采用酶联免疫吸附法测定患者血浆sST2水平。依据临床病史、体格检查及心电图、超声心动图等综合检查结果确诊为心衰的患者为病例组,非心衰患者为对照组,比较单独应用超声、血浆sST2诊断心衰效能;按照左心室射血分数(LVEF)及利钠肽、临床症状等将心衰患者分为降低型心衰组(HF-rEF组)、射血分数保留型心衰组(HF-pEF组)及射血分数中间值型心衰组(HF-mrEF组),比较不同组患者的超声特点及sST2水平,计算二者单独及联合鉴别不同类型心衰的效能。结果超声联合sST2诊断心衰时灵敏度为93.3%,特异度为67.2%,曲线下面积(AUC)为0.967;HF-rEF组的LAVI显著高于HF-pEF组、HF-mrEF组,IVSd值显著低于HF-pEF组、HF-mrEF组(P均<0.05);HF-rEF组的sST2为(95.64±35.23)ng/mL,显著高于HF-pEF组、HF-mrEF组的(54.27±26.85)ng/mL、(83.64±33.41)ng/mL,HF-mrEF组则显著高于HF-pEF组(P均<0.05),三组的LVPWd比较无统计学意义(P>0.05);联合诊断HE-rEF时,其灵敏度为73.7%,特异度为84.9%,曲线下面积(AUC)为0.867;联合鉴别HE-pEF时,其灵敏度为79.6%,特异度为89.5%,曲线下面积(AUC)为0.917。结论超声联合sST2较单一检查不同类型的心衰优势明显,可提高诊断效能,有助于临床进行疾病鉴别。

Clinical application of ultrasound combined with sST2 in different types of heart failure

Objective:To investigate the application value of ultrasound combined with soluble growth stimulation expressed gene 2(sST2)in different types of heart failure.Methods:117 patients with suspected heart failure admitted to this hospital from July 2018 to October 2019 were selected as the study subjects.After the patients were admitted to the hospital,the heart was examined by echocardiography,cubital venous blood was drawn,and the plasma sST2 level of the patients was measured by enzyme-linked immunosorbent assay.Patients diagnosed with heart failure based on clinical history,physical examination and electrocardiogram,echocardiography and other comprehensive examinations were included in the case group,and patients without heart failure were included in the control group.The efficacy of separate application of ultrasound or plasma sST2 in diagnosing heart failure was compared.According to left ventricular ejection fraction(LVEF),natriuretic peptide and clinical symptoms,the patients with heart failure were divided into heart failure with reduced ejection fraction group(HF-rEF group),heart failure with preserved ejection fraction group(HF-pEF group)and heart failure with median ejection fraction group(HF-mrEF group).The ultrasound characteristics and sST2 level were compared among patients in different groups,and the efficacy of the two alone and in combination in distinguishing different types of heart failure was calculated.Results:The sensitivity,specificity and the area under the curve(AUC)of ultrasound combined with sST2 in the diagnosis of heart failure were 93.3%,67.2%and 0.967.The LAVI of the HF-rEF group was significantly higher than that of the HF-pEF group and the HF-mrEF group while the IVSd value was significantly lower than that in HF-pEF group and HF-mrEF group(all P<0.05).The sST2 of the HF-rEF group was significantly higher than that of the HF-pEF group and the HF-mrEF group(95.64±35.23)ng/mL vs.(54.27±26.85)ng/mL vs.(83.64±33.41)ng/mL],and the sST2 of the HF-mrEF group was significantly higher than that of the HF-pEF group(all P<0.05),and there was no statistically significant difference in the LVPWd among the three groups(P>0.05).The sensitivity,specificity and the area under the curve(AUC)of combined diagnosis of HE-rEF were 73.7%,84.9%and 0.867.The sensitivity,specificity and the area under the curve(AUC)of combined identification of HE-pEF were 79.6%,89.5%and 0.917.Conclusion:Ultrasound combined with sST2 has obvious advantages over a single examination of different types of heart failure,and it can improve the diagnostic efficacy and help clinical disease identification.