血清sST2在心力衰竭诊断、预后中的应用价值

Application value of serum sST2 in diagnosis and prognosis of heart failure

摘要:

心力衰竭 (心衰) 的发病率正随着人口老龄化的加速而显著上升，目前仍然是一个重大的公共健康问题。尽管近年来在心衰治疗方面取得了显著成效，但患者的生存率依旧很低，预后差，确诊心衰后5年内死亡率高达50%。如果能够对心衰进行快速有效的诊断并按危险程度进行合理分层，将为临床医生制定治疗方案提供重要的参考依据。生物标志物在心衰的诊断、疗效评估及预后判断方面都具有重要的意义。心力衰竭是一种复杂的疾病，涉及多种生理病理过程。心力衰竭时，神经内分泌系统被激活，同时伴随着血容量和心室壁压力增加，心室肌细胞分泌NT-proBNP/BNP，因此，其可作为心衰诊断和预后生物标志物。然而血浆中NT-proBNP/BNP易受到年龄、性别、体型、左室肥大、心动过速、右心室过载、低氧血症、肾脏功能等诸多因素影响。sST2作为一种新型心力衰竭标志物，近年来备受关注，它不仅能够反映心肌纤维化程度并预测是否发生心室重构，且不受年龄、性别、肾功能等因素的影响，同时具有更低的参考变化值和个体指数，更适合用于连续监测和指导治疗，是评价心力衰竭的理想指标之一。文中对近年来sST2在心衰诊断和预后方面的研究进展进行总结归纳，并对其发展趋势进行展望。

Abstract:

The incidence of heart failure (HF) increases significantly as people age. HF remains a major concern in public health. Although remarkable achievements have been made to treat heart failure in recent years, the survival rate of patients is still very low and the prognosis is poor. The mortality rate within 5 years after the diagnosis of heart failure is up to 50%. If we can quickly and effectively diagnose heart failure and reasonably stratify according to the risk, it will provide a solid foundation for clinicians to formulate treatment plans. Biomarkers play an important role in the diagnosis, curative effect evaluation and prognosis of heart failure. Heart failure is a complex disease in which various pathophysiological processes are involved over time. When heart failure occurs, neuroendocrine system is activated. With the increase of blood volume and ventricular wall pressure, ventricular myocytes secrete NT-proBNP/BNP. Therefore, NT-proBNP/BNP can be used as a biomarker for diagnosis and prognosis of heart failure. However, NT-proBNP/BNP in plasma is easily affected by many factors such as age, sex, body type, left ventricular hypertrophy, tachycardia, right ventricular overload, hypoxemia, and kidney function. As a novel marker of heart failure, sST2 has attracted much attention in recent years. It can reflect the degree of myocardial fibrosis and predict whether ventricular remodeling will occur. It is worth noting that sST2 is not affected by age, gender and renal function and other factors. Also, with low reference change values and individuality index values, sST2 seems to be the best candidate for monitoring and guided therapy. In short, sST2 is one of the ideal indicators to evaluate heart failure. This review summarizes the research progress of sST2 in the diagnosis and prognosis of heart failure in recent years, and provides perspectives for its future development.