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目的:分析心力衰竭(HF)患者N端脑钠肽前体(NT-proBNP)、B型钠尿肽(BNP)、可溶性人基质裂解素(sST2)的临床诊断及预后价值.方法:153例HF患者(HF组)分别测定血NT-proBNP、BNP与sST2水平.参照NYHA心功能分级将HF患者分Ⅱ级(73例)、Ⅲ级(56例)、Ⅳ级(24例).另选取同期健康体检者共75例作为对照组.综合统计分析HF患者不同心功能分级组间NT-proBNP、BNP与sST2水平变化;比较NT-proBNP、BNP、sST2及3指标联合对HF患者死亡状况的预测价值.应用多因素Cox回归模型分析NT-proB-NP、BNP、sST2水平与HF患者死亡的相关性.结果:与对照组相比,HF组NT-proBNP、BNP和sST2水平明显升高(均P＜0.01).随着NYHA分级增加,HF患者血中NT-proBNP、BNP和sST2水平也相应升高(均P＜0.05).ROC结果表明,sST2诊断HF的ROC曲线下面积略高于NT-proBNP、BNP,分别为0.921、0.908、0.890(均P＜0.05).随访死亡患者11例(7.19％);1年内死亡患者血NT-proBNP、BNP、sST2水平明显高于未死亡患者(均P＜0.05);多因素Cox回归模型分析发现,患者基线NT-proBNP、BNP、sST2水平与死亡明显相关(OR=1.86);sST2对预后判断的ROC曲线下面积(0.792)与BNP (0.778)、NT-proBNP(0.801)差异不大,而三者联合应用预测效果(0.859)明显提高.结论:HF患者血NT proBNP、BNP、sST2水平与临床及生化变量密切相关,三者联合应用能够增强对HF患者死亡的预测能力.“,”Objective:To analyse values of clinical diagnosis and prognosis of N-terminal brain natriuretic peptide (NT-proBNP),B-brain natriuretic peptide (BNP) and soluble matrix cracking element (sST2) in patients with heart failure (HF).Method:A total of 153 patients with HF (HF group) were included,and levels of blood NT-proBNP,BNP and sST2 were separately measured.All patients were included into NYHA Ⅱ (n=73),NY-HA Ⅲ (n=56) and NYHA Ⅳ (n=24) group.Other 75 healthy cases were choose as the control group.Levels of NT-proBNP,BNP and sST2 were comparedbetween the groups with different heart function classification;the predictive values of NT-proBNP,BNP,sST2 and combination of the three indexes in the death were compared.Multiariable Cox regression model was used to analyze the correlation among NT-proBNP,BNP and sST2 with the death in patients with HF.Result:Compared with control group,levels of NT-proBNP,BNP and sST2 increased significantly in HF group,and increased with the increase of NYHA classification (all P＜0.05).ROC results showed that the area under ROC (AUC) of sST2 (0.921) was slightly higher than those of NT-proBNP (0.908) and BNP (0.890) (all P＜0.05).Followed up for 1 years,11 patients (7.19％) were dead and whose NT-proB-NP,BNP and sST2 levels were significantly higher than survivors (all P＜0.05).Multiariable Cox analysis found that baseline NT-proBNP,BNP and sST2 levels were significantly related with death (OR=1.86).The AUC of sST2 for prognosis judgment was 0.792,similar to BNP (AUC=0.778) and NT-proBNP (AUC=0.801) but higher than the combine of the three indexes (AUC=0.859).Conclusion:Blood NT-proBNP,BNP and sST2 levels are closely related to clinical and biochemical variables in patients with HF.Combination application of the three indexes can enhance the prediction ability of death.