2021 年第 3 期 第 16 卷

血清可溶性生长刺激表达基因2蛋白和高迁移率族蛋白B1对老年急性心力衰竭患者预后的评估价值

Evaluation value of serum soluble growth stimulation expressed gene 2 protein and high mobility group protein B1 on prognosis of elderly patients with acute heart failure

作者：金自慧杨大英

英文作者：Jin Zihui Yang Daying

单位：三亚中心医院海南省第三人民医院心内科572000

英文单位：Department of Cardiology Sanya Central Hospital the Third People′s Hospital of Hainan Province Sanya 572000 China

关键词：急性心力衰竭；可溶性生长刺激表达基因2蛋白；高迁移率族蛋白B1；预后

英文关键词：Acuteheartfailure;Solublegrowthstimulationexpressedgene2protein;HighmobilitygroupproteinB1;Prognosis 

• 摘要：

• 目的 探讨血清可溶性生长刺激表达基因2蛋白（sST2）和高迁移率族蛋白B1（HMGB1）对老年急性心力衰竭患者预后的评估价值。方法 选取三亚中心医院2019年4—10月收治的老年急性心力衰竭患者417例，根据患者1年内有无发生不良心血管事件分为预后不良组（114例）和预后良好组（303例）。比较2组患者住院时的基本临床资料、生化指标以及血清sST2和HMGB1水平，分析老年急性心力衰竭患者1年内预后不良的危险因素，以及sST2和HMGB1对老年急性心力衰竭患者预后不良的诊断价值。结果 预后不良组年龄、纽约心脏病协会心功能分级Ⅲ/Ⅳ级比例和血清肌酸激酶同工酶、高敏C反应蛋白、N末端B型脑钠肽前体水平均高于预后良好组，而左心室射血分数低于预后良好组（均P<0.05）。预后不良组患者血清sST2和HMGB1水平均高于预后良好组［(2 219±347)μg/L比（1 142±254）μg/L，(5.5±2.3)μg/L比（2.8±1.2）μg/L］，差异均有统计学意义（均P＜0.001）。多因素Logistic回归分析结果显示年龄、sST2、HMGB1、N末端B型脑钠肽前体、纽约心脏病协会心功能分级为Ⅲ/Ⅳ级均是老年急性心力衰竭患者预后不良的危险因素（比值比=1.847、2.157、2.045、1.796、2.695，均P<0.05）。sST2和HMGB1二者联合预测老年急性心力衰竭患者预后不良的曲线下面积大于sST2和HMGB1单独检测（0.923比0.810、0.832，均P<0.001）。结论 sST2和HMGB1均是老年急性心力衰竭患者预后不良的危险因素，二者联合检测对老年急性心力衰竭患者预后不良的诊断效能高于二者单独检测。

• Objective To investigate the evaluation value of serum soluble growth stimulation expressed gene 2 protein (sST2) and high mobility group protein B1 (HMGB1) on the prognosis of elderly patients with acute heart failure. Methods From April to October 2019, 417 elderly patients with acute heart failure admitted to Sanya Central Hospital, Hainan Province were selected. They were divided into poor prognosis group (114 cases) and good prognosis group (303 cases) according to whether there were adverse cardiovascular events within 1 year. The basic clinical data, biochemical indexes and serum levels of sST2 and HMGB1 were compared between the two groups. The risk factors of poor prognosis in elderly patients with acute heart failure within 1 year were analyzed, and the diagnostic value of sST2 and HMGB1 for poor prognosis of elderly patients with acute heart failure was analyzed. Results The age, New York Heart Association (NYHA) cardiac function grade Ⅲ/Ⅳ ratio and serum creatine kinase isoenzyme, high- sensitivity C- reactive protein and N- terminal pro- brain natriuretic peptide (NT- proBNP) levels in poor prognosis group were higher than those in good prognosis group, while the left ventricular ejection fraction in poor prognosis group was lower than that in good prognosis group (all P＜0.05). The serum levels of sST2 and HMGB1 in poor prognosis group were higher than those in good prognosis group ［(2 219±347)μg/L vs (1 142±254)μg/L, (5.5±2.3)μg/L vs (2.8±1.2)μg/L］, and the differences were statistically significant (both P<0.001). Multivariate Logistic regression analysis showed that age, sST2, HMGB1, NT- proBNP and NYHA cardiac function grade Ⅲ/Ⅳ were risk factors for poor prognosis in elderly patients with acute heart failure (odds ratio=1.847, 2.157, 2.045, 1.796, 2.695, all P＜0.05). The area under the curve for predicting poor prognosis of elderly patients with acute heart failure by combination of sST2 and HMGB1 was larger than that of sST2 and HMGB1 alone (0.923 vs 0.810, 0.832, both P<0.001). Conclusions Both sST2 and HMGB1 are risk factors for poor prognosis in elderly patients with acute heart failure. The diagnostic efficacy of combined detection of sST2 and HMGB1 for poor prognosis in elderly patients with acute heart failure is higher than those of single detection.