[Diagnostic value of combining serum soluble ST2 and interleukin-33 for heart failure patients with preserved left ventricular ejection fraction].

Objective: Diagnostic efficacy of serum markers is low for heart failure patients with preserved left ventricular ejection fraction (HF-pEF) as compared to heart failure patients with reduced left ventricular ejection fraction.We sought to explore the diagnostic value of serum levels of soluble ST2 (sST2) combined with interleukin-33 (IL-33) for the diagnosis of HF-pEF in this study. Methods: A total of 376 patients with HF-pEF (HF group), 376 matched-control patients without heart failure who shared similar clinical characteristics (non-HF group) were included in the study.Another 500 healthy individuals were recruited for assessing the normal ranges of IL-33 and sST2.Serum levels of NT-proBNP were measured by chemi-luminescence assay, while IL-33 and sST2 were measured by enzyme linked immunosorbent assay. Results: Serum levels of IL-33 and sST2 were not normally distributed in healthy population.Serum concentrations of IL-33 and sST2 were significantly higher in HF-pEF patients than in patients in non-HF group (median, IL-33: 0.437 μg/L vs. 0.127 μg/L, P<0.01; sST: 0.118 μg/L vs. 0.067 μg/L, P<0.01). The area under receiver operating characteristic curve (AUC) of sST2 for detecting HF-pEF was 0.763 (95%CI 0.729-0.795, P<0.01), with 71.01% sensitivity and 66.75% specificity, the AUC was 0.884 (95%CI 0.859-0.908, P<0.01), with 80.05% sensitivity and 81.91% specificity in patients with serum IL-33 higher than 0.117 μg/L (median level of serum IL-33 in healthy individuals, n=306). The AUC of NT-proBNP for detecting HF-pEF was 0.83, with 74.73% sensitivity and 84.57% specificity.The AUC of sST2 for detecting HF-pEF was significantly higher than NT-proBNP in population with high serum IL-33 (AUC: 0.88 vs. 0.83, P<0.01). Conclusion: Serum sST2 could serve as a satisfactory biomarker for HF-pEF diagnosis, especially for patients with high serum IL-33 concentrations.目的： 探讨血清可溶性ST2(sST2)联合白细胞介素-33(IL-33)应用于辅助诊断射血分数保留的心力衰竭(HF-pEF)的效能。 方法： 纳入中山大学孙逸仙纪念医院2010年1月至2014年12月于心血管内科住院的HF-pEF患者共376例(HF组)，纳入同期临床基本资料匹配而无心力衰竭的患者376例作为对照(非HF组)；另纳入健康体检者500名以确立IL-33及sST2的正常值范围。应用免疫酶联吸附方法检测血清sST2及IL-33水平，化学发光法检测N末端B型利钠肽原(NT-proBNP)水平，采用受试者工作特征曲线(ROC)分析sST2用于辅助诊断HF-pEF的效能。 结果： 血清IL-33及sST2浓度在人群中呈偏态分布，HF组患者血清IL-33及sST2水平均显著高于非HF组(中位数，IL-33：0.437 μg/L比0.127 μg/L，P<0.01；sST：0.118 μg/L比0.067 μg/L，P<0.01)。sST2用于辅助诊断HF-pEF最佳切点值为0.159 μg/L，此时ROC下面积为0.763(95%CI 0.729～0.795，P<0.01)，敏感度为71.01%，特异度为66.75%；健康体检人群中位血清IL-33水平为0.117 μg/L，当仅纳入血清IL-33高于此值的HF-pEF患者(n＝306)时，sST2用于辅助诊断HF-pEF的ROC下面积为0.884(95%CI 0.859～0.908，P<0.01)，敏感度为80.05%，特异度为81.91%。在高IL-33水平人群中，sST2用辅助诊断HF-pEF的ROC下面积大于NT-proBNP(0.88比0.83，P<0.01)。 结论： 血清sST2可用于辅助诊断HF-pEF，联合测定IL-33可进一步提高诊断效能。.