实时三维超声心动图联合血清NT-proBNP、MR-proADM、sST2对心力衰竭患者诊断及预后的评估价值

摘要 目的：探讨实时三维超声心动图（RT-3DE）联合血清N末端脑钠肽前体（NT-proBNP）、肾上腺髓质素前体中段肽（MR-proADM）、可溶性人基质裂解素2（sST2）对心力衰竭（HF）患者诊断及预后的评估价值。方法：选择2020年3月至2022年10月阳光融和医院收治的112例HF患者（HF组），另选择同期体检健康的50例志愿者（对照组）。所有受试者均接受RT-3DE检查，同时检测血清NT-proBNP、MR-proADM、sST2水平。对比两组RT-3DE参数和血清NT-proBNP、MR-proADM、sST2水平。HF患者出院后随访6个月，统计患者预后情况；根据预后将患者分为预后不良组（37例）和预后良好组（75例）。受试者工作特征（ROC）曲线分析RT-3DE参数联合血清NT-proBNP、MR-proADM、sST2诊断HF的临床价值及对预后不良的预测价值。结果：HF组左室收缩末期容积（LVESV）、左室舒张末期容积（LVEDV）、左室舒张末期容积指数（LVEDVI）、收缩末期容积指数（LVESVI）、血清NT-proBNP、MR-proADM、sST2水平高于对照组（P＜0.05），左室射血分数（LVEF）低于对照组（P＜0.05）。RT-3DE参数联合血清NT-proBNP、MR-proADM、sST2诊断HF的曲线下面积（AUC）为0.902，高于各指标单独诊断。预后不良组LVESV、LVEDV、LVEDVI、LVESVI、血清NT-proBNP、MR-proADM、sST2水平高于预后良好组（P＜0.05），LVEF低于预后良好组（P＜0.05）。RT-3DE参数联合NT-proBNP、MR-proADM、sST2预测HF预后不良的AUC为0.937，高于各指标单独预测。结论：HF患者LVESV、LVEDV、LVEDVI、LVESVI、血清NT-proBNP、MR-proADM、sST2水平增高，LVEF降低，联合RT-3DE参数和血清NT-proBNP、MR-proADM、sST2可提高对HF诊断和预后预测的效能。

Value of Real-Time Three-Dimensional Echocardiography Combined with Serum NT-proBNP, MR-proADM and sST2 in Diagnosis and Prognosis of Patients with Heart Failure

ABSTRACT Objective: To investigate the value of real-time three-dimensional echocardiography (RT-3DE) combined with serum N-terminal pro-brain natriuretic peptide(NT-proBNP), mid-regional pro-adrenomedullin(MR-proADM) and soluble suppression of tumorigenicity 2 (sST2) in the diagnosis and prognosis of patients with heart failure (HF). Methods: 112 HF patients (HF group) admitted to Sunshine Union Hospital from March 2020 to October 2022 were selected, and another 50 volunteers (control group) who underwent physical examination during the same period were selected. All subjects underwent RT-3DE examination, and serum NT-proBNP, MR-proADM and sST2 levels were detected. RT-3DE parameters and serum NT-proBNP, MR-proADM, sST2 levels were compared between two groups. HF patients were followed up for 6 months after discharge, and the prognosis situation of patients were counted; patients were divided into poor prognosis group (37 cases) and good prognosis group (75 cases) according to the prognosis. The clinical value of RT-3DE parameters combined with serum NT-proBNP, MR-proADM and sST2 in the diagnosis of HF and the predictive value for poor prognosis were analyzed by receiver operating characteristic (ROC) curve. Results: The levels of left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic volume index (LVEDVI), end-systolic volume index (LVESVI), serum NT-proBNP, MR-proADM and sST2 in HF group were higher than those in control group (P<0.05), and left ventricular ejection fraction (LVEF) was lower than that in control group (P<0.05). The area under the curve (AUC) of RT-3DE parameters combined with serum NT-proBNP, MR-proADM and sST2 in the diagnosis of HF was 0.902, which was higher than that of each index alone. LVESV, LVEDV, LVEDVI, LVESVI, serum NT-proBNP, MR-proADM and sST2 levels in poor prognosis group were higher than those in good prognosis group (P<0.05), and LVEF was lower than that in good prognosis group (P<0.05). The AUC of RT-3DE parameters combined with NT-proBNP, MR-proADM and sST2 in predicting the poor prognosis of HF was 0.937, which was higher than that of each index alone. Conclusion: The levels of LVESV, LVEDV, LVEDVI, LVESVI, serum NT-proBNP, MR-proADM and sST2 increased and LVEF decreased in HF patients, RT-3DE parameters combined with serum NT-proBNP, MR-proADM and sST2 could improve the efficacy of HF diagnosis and prognosis prediction.