| 赵志杰,刘青,李鹏飞,等.基于决策曲线分析研究血清 sST2、sCD40L与老年严重失代偿期急性心力衰竭病人预后的关系[J].安徽医药,2025,29(6):1197-1202. |
| 基于决策曲线分析研究血清 sST2、sCD40L与老年严重失代偿期急性心力衰竭病人预后的关系 |
| Decision curve-based analysis of the relationship between serum sST2, sCD40L and prognosis in elderly patients with severe decompensated acute heart failure |
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| DOI：10.3969/j.issn.1009-6469.2025.06.027 |
| 中文关键词: 急性心力衰竭 代偿失调 可溶性生长刺激表达基因 2蛋白 可溶性 CD40配体 决策曲线分析 预后 老年人 |
| 英文关键词: Acute heart failure Decompensation Soluble suppression of tumorigenicity-2 Soluble cluster of differentiation 40 ligand Decision curve analysis Prognosis Aged |
| 基金项目:河北省 2022年度医学科学研究课题计划项目( 20220323) |
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| 中文摘要: |
| 目的基于决策曲线分析( DCA)研究血清可溶性生长刺激表达基因 2蛋白( sST2)、可溶性 CD40配体( sCD40L)与老年严重失代偿期急性心力衰竭( AHF)病人预后的关系。方法选取 2021年 5月至 2022年 5月沧州市人民医院收治的 225例老年严重失代偿期 AHF病人，均检测其入院 24 h内血清 sST2、sCD40L水平。根据病人出院后 6个月的存活情况分为存活组与死亡组，采用 Cox回归模型分析血清 sST2、sCD40L水平与老年严重失代偿期 AHF病人预后的关系，采用受试者操作特征曲线(ROC曲线)分析血清 sST2、sCD40L水平的预后预测价值。根据 ROC曲线最佳截断值将病人分为高表达组和低表达组，绘制 Kaplan-Meier曲线分析高表达组和低表达组病人生存率。采用 DCA评估血清 sST2、sCD40L水平对老年严重失代偿期 AHF病人的预后价值。结果 225例病人出院 6个月后获得完整随访 215例，其中死亡 40例，病死率为 18.60%。死亡组年龄及血清脑利尿钠肽( BNP)、 N端脑利尿钠肽前体( NT-proBNP)、 sST2［( 70.59±8.85)μg/L比( 61.40±9.27)μg/L］、 sCD40L［( 62.15±7.42) mg/L比( 52.32±6.69)mg/L］水平均高于存活组( P<0.001)。 Cox回归模型分析显示，年龄大及血清 NT-proBNP、sST2［HR=2.30， 95%CI:(1.35，3.24)］、 sCD40L［HR=1.84，95%CI:(1.05，2.63)］水平升高均是影响老年严重失代偿期 AHF病人预后的危险因素(P<0.01)。 ROC曲线分析显示，血清 sST2、sCD40L二者联合预测老年严重失代偿期 AHF病人预后的 AUC为 0.89，高于单一指标检测的 AUC(0.79、0.78)。 sST2高表达组生存率低于 sST2低表达组， sCD40L高表达组生存率低于 sCD40L低表达组( P<0.05)。 DCA显示，在 0~0.40的高风险阈值区间内，净受益率呈正值且有临床意义，全阳性阈值降低至 0.15时，血清 sST2、 sCD40L及二者联合可获得最大净受益率，且在该阈值范围内，联合预测模型净受益率大于二者单独预测。结论高水平血清 sST2、sCD40L是老年严重失代偿期 AHF病人死亡的独立预测因素，二者联合检测可有效提高预测效能。 |
| 英文摘要: |
| Objective To analyse the relationship between serum soluble suppression of tumorigenicity-2 (sST2), soluble cluster ofdifferentiation 40 ligand (sCD40L) and the prognosis of elderly patients with acute heart failure (AHF) in severe decompensated phasebased on decision curves.Methods A total of 225 elderly patients with severe decompensated AHF admitted to Cangzhou People'sHospital from May 2021 to May 2022 were selected, and all of them were tested for serum sST2 and sCD40L levels within 24 h of ad-mission. The patients were divided into survival and death groups according to their survival at 6 months after discharge from the hospi-tal. Cox regression model was used to analyse the relationship between serum sST2 and sCD40L levels and the prognosis of elderly pa-tients with severe decompensated AHF, and the prognostic predictive value of serum sST2 and sCD40L levels was analyzed using a sub-ject operating characteristic (ROC) curve. Patients were divided into high expression and low expression groups according to the bestcut-off value of ROC, and Kaplan-Meier curves were plotted to analyse the survival rate of patients in the high expression and low ex-pression groups. Decision curve analysis (DCA) was used to analyse the prognostic value of serum sST2 and sCD40L levels on the prog-nosis of elderly patients with severe decompensated AHF.Results Complete follow-up was obtained in 215 of 225 patients 6 months after discharge, of which 40 died, with a case-fatality rate of 18.60%. Age and serum B-type natriuretie peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), sST2, and sCD40L levels in the death group were higher than those in the survival group [sST2: (70.59±8.85) μg/L vs (61.40±9.27) μg/L; sCD40L: (62.15±7.42) mg/L vs (52.32±6.69) mg/L] (P<0.001). Cox regression model analysis showed that older age and elevated levels of serum NT-proBNP, sST2 [HR=2.30, 95%CI: (1.35, 3.24)], and sCD40L [HR=1.84, 95%CI: (1.05, 2.63)] were risk factors for the prognosis of elderly patients with severe decompensated AHF (P<0.01). ROC curve analy-sis showed that the AUC of the combination of serum sST2 and sCD40L in predicting the prognosis of elderly patients with severe de‐compensated AHF was 0.89, which was higher than that of the single-indicator assay (0.79 and 0.78, respectively). Survival was lower in the sST2 high-expression group than in the sST2 low-expression group, and in the sCD40L high-expression group than in the sCD40L low-expression group (P<0.05). DCA showed that the net benefit rate was positive and clinically significant in the high-risk threshold interval from 0 to 0.40, and when the total positive threshold was reduced to 0.15, serum sST2, sCD40L as well as the combi-nation of serum sST2 and sCD40L could obtain the maximum net benefit rate, and within the threshold range, the net benefit rate of thecombined prediction model was greater than that of either predictor alone.Conclusion High levels of serum sST2 and sCD40L are in-dependent predictors of death in elderly patients with severe decompensated AHF, and combined testing of the two can effectively im-prove the predictive efficacy. |
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