血清可溶性生长刺激表达因子2、氨基末端B型脑钠肽前体及超声心动图参数与急性心肌梗死后心力衰竭患者心肌重塑的关系

doi:10.3969/j.issn.1006-5725.2025.19.011

Abstract

Abstract:

Objective To study the association between serum soluble growth stimulating expression factor 2 （sST2）， N?terminal pro?B?type natriuretic peptide （NT?probNP）， and echocardiographic parameters with myocardial remodeling in patients with heart failure （HF） after acute myocardial infarction （AMI）. Methods A total of 120 patients with HF after AMI admitted to the hospital from January 2023 to January 2024 were enrolled. According to the results of echocardiography during a 6?month follow?up， the enrolled patients were divided into a myocardial remodeling group and a non?myocardial remodeling group. Serum sST2， NT?proBNP and echocardiographic parameters were compared between groups， and the predictive value on myocardial remodeling was analyzed. Results According to the Killip heart failure classification， the patients were classified into three groups. The sST2， NT?proBNP， left ventricular end?diastolic diameter （LVEDD）， left ventricular end?systolic diameter （LVESD） and left atrial diameter （LAD） showed progressive increase in the three groups， Killip Ⅱ to Killip Ⅳ （P < 0.05）. Conversely， left ventricular ejection fraction （LVEF） decreased across the three groups （P < 0.05）. Multivariate analysis found that high sST2， high NT?proBNP and high LAD were independent risk factors of myocardial remodeling in patients with HF after AMI （P < 0.05）. ROC curve revealed that the area under the curve （AUC） of the nomogram model was 0.82 （95%CI： 0.71 ~ 0.92）. Hosmer?Lemeshow goodness of fit test of the model indicated that the chi?square value was 3.67 （χ² = 3.67， P = 0.801）， and it was considered that basic consistency was exhibited between the fitted probability value and actual probability value. After 1 000 times of Bootstrap repeated sampling， the calibration curve was drawn and found that the calibration curve had good consistency with the actual curve， and both were close to the ideal curve. Decision curve displayed that the net benefit of patients was higher than that of the other two extreme curves， and when the threshold probability was between 0.16 and 0.94， the model could produce better clinical benefits. Conclusion The nomogram prediction model based on serum sST2， NT-proBNP and echocardiographic parameters has high predictive value on myocardial remodeling in HF patients after AMI.

Key words: soluble growth stimulation expressed gene 2, n-terminal pro-brain natriuretic peptide, echocardiography, acute myocardial infarction, heart failure, myocardial remodeling

CLC Number:

R542.2

Xin WU,Geqi DING,Lufeng LI,Tie HU,Fei. ZENG. Association of serum sST2， NT⁃proBNP and echocardiographic parameters with myocardial remodeling in patients with heart failure after acute myocardial infarction[J]. The Journal of Practical Medicine, 2025, 41(19): 3034-3040.

Figures/Tables 8

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References 26

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临床资料	Killip Ⅱ级组（n = 36）	Killip Ⅲ级组（n = 61）	Killip Ⅳ级组（n = 23）	χ²/F值	P值
年龄/岁	61.47 ± 9.50	62.39 ± 9.17	64.53 ± 7.75	0.821	0.443
性别/例				1.330	0.514
男	22	43	17
女	14	18	6
糖尿病/［例（%）］	7（19.44）	13（21.31）	5（21.74）	0.062	0.969
高血压/［例（%）］	14（38.89）	34（55.74）	15（68.18）	5.096	0.078
冠心病家族史/［例（%）］	2（5.56）	4（6.56）	4（17.39）	3.086	0.214
sST2/（ng/mL）	59.48 ± 9.75	68.51 ± 12.82	82.13 ± 15.17	23.081	< 0.001
NT?proBNP/（ng/L）	674.27 ± 183.96	880.61 ± 204.79^?	1026.34 ± 257.96^?△	21.325	< 0.001
LVEDD/mm	53.29 ± 5.47	57.05 ± 5.96^?	60.96 ± 6.26^?△	12.210	< 0.001
LVESD/mm	44.95 ± 6.96	47.08 ± 5.31^?	52.75 ± 5.38^?△	12.774	< 0.001
LVEF/%	43.63 ± 5.28	40.56 ± 5.17^?	37.36 ± 4.46^?△	10.925	< 0.001
LAD/mm	38.13 ± 4.70	43.39 ± 5.59	46.80 ± 6.47	19.029	< 0.001

临床资料	心肌重塑组（n = 31）	非心肌重塑组（n = 89）	χ²/t/Z值	P值
年龄/岁	63.59 ± 10.04	62.14 ± 9.85	0.702	0.483
性别/例			0.958	0.328
男	12	26
女	19	63
糖尿病/［例（%）］	9（29.03）	16（17.98）	1.704	0.192
高血压/［例（%）］	19（61.29）	44（49.44）	1.295	0.255
冠心病家族史/［例（%）］	3（9.68）	7（7.87）	0.099	0.753
心功能分级/［例（%）］			10.702	0.001
Ⅱ级	6（19.35）	30（33.71）
Ⅲ级	11（35.48）	50（56.18）
Ⅳ级	14（45.17）	9（10.11）
sST2/（ng/mL）	84.38 ± 17.02	62.85 ± 15.48	6.498	< 0.001
NT?proBNP/（ng/L）	1003.64 ± 224.36	791.95 ± 195.63	4.992	< 0.001
LVEDD/mm	58.57 ± 7.92	56.01 ± 6.53	1.776	0.078
LVESD/mm	48.73 ± 5.64	47.11 ± 5.16	1.469	0.144
LVEF/%	38.93 ± 4.86	41.51 ± 5.57	2.291	0.023
LAD/mm	45.59 ± 4.93	41.37 ± 3.68	5.015	< 0.001

变量	β	SE	Wald χ²	P值	OR（95%CI）
sST2	0.415	0.198	4.393	0.037	1.514（1.027 ~ 2.232）
NTproBNP	1.019	0.332	9.420	0.002	2.770（1.445 ~ 5.311）
LAD	0.606	0.277	6.019	0.015	1.833（1.130 ~ 2.975）

Association of serum sST2， NT⁃proBNP and echocardiographic parameters with myocardial remodeling in patients with heart failure after acute myocardial infarction

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