高血压合并心力衰竭患者血清同型半胱氨酸、氨基末端脑利尿钠肽前体和可溶性生长刺激表达基因2蛋白与心脏重构的关系及对心血管预后不良的预测价值

The relationship between serum homocysteine, N-terminal pro-brain natriuretic peptide, soluble growth stimulation-expressed gene 2 protein and cardiac remodeling in patients with hypertension and heart failure, and their predictive value for adverse cardiovascular prognosis

    摘要
  • 摘要:
    目的 观察高血压合并心力衰竭患者血清同型半胱氨酸（Hcy）、氨基末端脑利尿钠肽前体（NT-proBNP）、可溶性生长刺激表达基因2蛋白（sST2）表达情况，探讨其与心脏重构的关系和对心血管预后不良的诊断价值。
    方法  选取2021年3月至2023年4月于衡水市人民医院接受治疗的高血压合并慢性心力衰竭（心衰）患者256例为高血压合并慢性心衰组，单纯原发性高血压患者256例为单纯原发性高血压组。比较两组受试者血清Hcy、NT-proBNP和sST2表达情况，采用Pearson相关性分析法分析血清指标与心脏重构指标的相关性。统计分析高血压合并心力衰竭患者出院后1年内主要心血管不良事件（MACE）发生情况，分析高血压合并心力衰竭患者发生MACE的影响因素，及血清Hcy、NT-proBNP、sST2对MACE的诊断效能。
    结果  高血压合并慢性心衰组患者的血清Hcy、NT-proBNP和sST2水平以及收缩压、舒张压高于单纯原发性高血压组（t=16.077、14.563、15.715、4.631、3.545，均P＜0.05）。高血压合并慢性心衰组患者的血清Hcy、NT-proBNP和sST2水平与左心室质量指数（LVMI）呈正相关（r=0.653, 0.515、0.621，均P＜0.05）。高血压合并慢性心衰组患者随访1年，预后不良76例（29.69%），预后良好180例（70.31%）。高血压合并慢性心衰组中预后不良患者血清Hcy、NT-proBNP和sST2水平以及LVMI、左心室舒张末期内径（LVEDD）高于预后良好患者（t=4.675、5.973、4.461、7.346、3.178，均P＜0.05），纽约心脏协会（NYHA）心功能分级Ⅱ级占比、左室射血分数（LVEF）低于预后良好患者（χ2=23.339、t=2.330，均P＜0.05）。Cox回归分析显示，NYHA分级、血清Hcy、NT-proBNP和sST2水平以及LVMI是影响MACE的危险因素（P＜0.05）。血清sST2、Hcy、NT-proBNP预测预后不良的最佳截断值分别为37.01 µg/L、15.65 μmol/L、990.83 ng/L，曲线下面积分别为0.848（95%CI: 0.786～0.902）、0.798（95%CI: 0.742～0.866）、0.828（95%CI:0.767～0.887）。Hcy ≥ 15.65 μmol/L、NT-proBNP ≥ 990.83 ng/L、sST2 ≥ 37.01 μg/L患者的MACE发生率升高（均P＜0.05），Kaplan-Meier分析显示，其累积无事件生存率明显降低（Log-rank均P＜0.05）。
    结论  高血压合并心力衰竭患者的血清NT-proBNP、sST2、Hcy处于高表达状态，且表达水平与心脏重构呈正相关，对于预后不良具有良好的诊断价值。

     

    Abstract:
    Objective To observe the serum levels of homocysteine (Hcy), N-terminal pro-brain natriuretic peptide (NT-proBNP), and soluble growth stimulation-expressed gene 2 protein (sST2) in patients with hypertension and heart failure, and to investigate their relationship with cardiac remodeling and their diagnostic value for adverse cardiovascular prognosis.
    Methods A total of 256 patients with hypertension and chronic heart failure admitted to Hengshui People's Hospital from March 2021 to April 2023 were selected as the hypertension with chronic heart failure group, and 256 patients with essential hypertension alone were selected as the essential hypertension alone group. The serum levels of Hcy, NT-proBNP, and sST2 were compared between the two groups. Pearson correlation analysis was used to analyze the correlation between serum indicators and cardiac remodeling indicators. The incidence of major adverse cardiovascular events (MACE) within 1 year after discharge in patients with hypertension and heart failure was statistically analyzed. The influencing factors for MACE occurrence in patients with hypertension and heart failure were analyzed, as well as the diagnostic efficacy of serum Hcy, NT-proBNP, and sST2 for MACE.
    Results The serum levels of Hcy, NT-proBNP, sST2, systolic blood pressure, and diastolic blood pressure in the hypertension with chronic heart failure group were higher than those in the essential hypertension alone group (t=16.077, 14.563, 15.715, 4.631, 3.545, all P＜0.05). In the hypertension with chronic heart failure group, serum levels of Hcy, NT-proBNP, and sST2 were positively correlated with left ventricular mass index (LVMI) (r=0.653, 0.515, 0.621, all P＜0.05). During the 1-year follow-up of the hypertension with chronic heart failure group, 76 patients (29.69%) had a poor prognosis, and 180 patients (70.31%) had a good prognosis. In the hypertension with chronic heart failure group, patients with a poor prognosis had higher serum levels of Hcy, NT-proBNP, sST2, LVMI, and left ventricular end-diastolic diameter (LVEDD) than those with a good prognosis (t=4.675, 5.973, 4.461, 7.346, 3.178, all P＜0.05). The proportion of patients with New York Heart Association (NYHA) class Ⅱ heart function and left ventricular ejection fraction (LVEF) were lower in the poor prognosis group than in the good prognosis group (χ2=23.339, t=2.330, both P＜0.05). Cox regression analysis showed that NYHA classification, serum levels of Hcy, NT-proBNP, sST2, and LVMI were risk factors for MACE (P＜0.05). The optimal cut-off values of serum sST2, Hcy, and NT-proBNP for predicting poor prognosis were 37.01 µg/L, 15.65 μmol/L, and 990.83 ng/L, respectively, with areas under the curve of 0.848 (95%CI: 0.786 to 0.902), 0.798 (95%CI: 0.742 to 0.866), and 0.828 (95%CI: 0.767 to 0.887), respectively. The incidence of MACE was higher in patients with Hcy ≥ 15.65 μmol/L, NT-proBNP ≥ 990.83 ng/L, and sST2 ≥ 37.01 μg/L (all P＜0.05). Kaplan-Meier analysis showed that their cumulative event-free survival rates were significantly lower (Log-rank all P＜0.05).
    Conclusion Serum levels of NT-proBNP, sST2, and Hcy are highly expressed in patients with hypertension and heart failure, and their expression levels are positively correlated with cardiac remodeling, showing good diagnostic value for poor prognosis.

     

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