NGHIEN CLTU S y K^T HOP SST2 VA BNP H U Y S T THANH TRONG TIEN Ll^QNG SUY TIM VA Tl> VONG TRONG 30 NGAY 6 BENH NHAN
NH6I MAU ca TIM CAP ST CHENH LEN
Hodng Anh Tien, Trdn Thf Thanh Tr&c, Vo Thdnh Nhdn Tru&ng Dgi hpc Y Duac - Bgi hpc Hue
Tdm tit
Md- dau: Ndng dp sST2 huyit thanh cd lifn quan dfn suy tim khdng do bfnh tim thilu miu cyc bg, nhung gia tri tien lugng ciia ST2 tren benh nhan nhfli mau co tim cip ST chfnh Ifn chua dugc nghifn cihi. Phuong phap nghien cuu: Nghien ciiu nflng dp sST2 trfn 38 bfnh nhin nhfli miu ca tim cip ST chenh len difu tri tai khoa Tim mgch can diifp Bfnh vifn Chp Riy va phan tich moi lifn quan gifla gii tri nong dp sST2 va blln co tim mach trong vdng 30 ngay. Kit qua: Do nflng dp sST2 huyit thanh liic nhip vifn d nhdm ddi tupng nfu trfn. Ndng dp sST2 lue nhap vifn cao cd lifn quan den tu suit (<35ng/ml so vdi >35 ng/ml, p= 0,01) va suy tim tiln triln (<35ng/ml so vdi >35 ng/ml, p= 0,002) trong vdng 30 ngiy theo ddi. Han nua, d bfnh nhan cd sST2>35ng/ml va BNP > 500 pg/ml thi cang cd lien quan din bifn cd tim mach ngng trong vdng 30 ngiy d bfnh nhan nhdi miu ca tim cip ST chenh Ifn (p<0,0001).
Ket luan: ST2 vi BNP cd gii tri tien lugng biln co tim mgch nhu' tii vong vi suy tim tiln triln d bfnh nhan nhdi miu co tim cip ST chfnh Ifn trong thdi gian 30 ngay.
Tu khoa: sST2, nhdi mdu co tim cdp ST chenh len, biin cd tim mgch.
Abstract
COMBINATION OF SST2 AND BNP IN PREDICTEVG THE MORTALITY OF ST- ELEVATION MYOCARDLUL INFARCTION
Hoang Anh Tien, Tran Thi Thanh True, Vo Thanh Nhan Hue University of Medicine and Pharmacy - Hue University
Background: Serum levels of ST2 are associated with prognosis in nonischemic heart failure, but the predictive value of ST2 in patients with ST elevation myocardial infarction is unknown. Methods:
The study included 38 STEMI patients at Interventional Cardiology Department of Cho Ray Hospital.
Correlation analysis was used to identify the relationship between the cardiac outcomes within 30 days from the onset of chest pain and sST2 value. Results: ST2 levels were measured in serum from 38 patients with STEMI. Baseline levels of ST2 were significantly higher in those patients who died (<35 ng/ml versus >35 ng/mL, p=0.01) or developed new congestive heart failure (< 35 ng/ml versus > 35 ng/mL, p=0.002) by 30 days. In an analysis of outcomes at 30 days by ST2 quartiles, both death (p=0.01) and the combined death/heart failure end point (p=0.001) showed a significant graded association with levels of ST2. Furthermore, when sST2> 35ng/ml and BNP > 500pg/ml showed a tightly relationship with cardiac outcomes within 30 days (p<0.0001). Conclusions: Senim levels of the interleukin-1 receptor family member ST2 predict mortality and heart failure in patients with STEMI. These data suggest that ST2 and BNP are the useful biomarker in short-term prognosis of cardiac events in STEMI.
Key words: sST2, BNP, STEMI, cardiac outcomes.
:,-Bid,chi liin hi: Hodng Anh Tiin, em ail: [email protected]
-Ngdy nhdn bdi: 19/2/2016 *Ngdy ddng fddng: 12/4/2016"*Ngdyxudtldn: 10/5/2016
Tgp chi Y Dugc hgc - Truimg Dgi hgc Y Dugc Hue - Sfl 32 g j
1. B^T VAN BE
Trong nen y hgc hifn dgi, chin doin suy tim Ii mpt phin quan trgng cua djch tl hgc. Chi rifng d Hoa Ky, khoing 550.000 trudng hgp suy tim mdi mic hing nim vi tin suit niy dy doin se gia ting hon nu^. Mpt Uong nhihig nguyen nhan giy nen difu niy la din s6 dang gii di, ti If mac cac ylu tfl nguy CO tim mach gia ting, ti If sdng cdn sau nhii miu ca tim cii thifn vi ti If chit tre do cic nguyen nhan khic giim di.
6 bfnh nhan suy tim cip, tang ap luc dfl diy tim thit va rdi logn chii-c ning tim thit gdp phan lim gia tang siic cing thinh tim va phong thich peptide Ipi nifu (BNP va NT-proBNP), Anh hudng bdi qui tii ip lyc vi the tich, BNP vi NT-proBNP cd lien quan din bit thudng ve cau true va chiic nang tim khi chflc nang tim thu va tam truang tim that xau di, buing tim gian, benh van tim va ting ip dpng mach phoi, Thim chi khi thfm vio dfl lifu sieu im tim, peptide Igi nifu vin cdn gia trj trong tifn lupng tu vong dii hgn va tien lupng tii nhap vien vi suy tim.
La mpt thinh vifn ciia gia dinh thy the Interleukin -1 (IL-1), ST2 la mpt diu an sinh hpc vl siic cing ca hpc, vi tii sip xip cic tin hifu ST2 din den hifn tugng tai cau true co tim.
Hon niia, khi b| nhdi miu co tim cip, nflng dp ST2 hda tan (sST2) cd lifn quan din gia tang nguy CO tir vong hay nguy co suy tim, dpc lip vdi peptide loi nifu, bit ki sy thay ddi nio trong ndng dp sST2 theo thdi gian cung la yfu to dy bao tifn lugng dpc lap vdi peptide Igi nifu. Hon n&a d bfnh nhin suy tim, nflng dp sST2 lifn quan mgnh me den dp ning suy tim vi dy doan tli suit 1 nim.
2. fi6l TirgfNG VA PHirONG PHAP NGHIEN CUtJ
2.1. Doi tirong nghien ciru
Tat ci bfnh nhin dupc chin doin nhii mau ca tim cip ST chenh Ifn (theo djnh nghTa lan thii 3 cua Hpi Tim mgch chiu Au (ESC) 2012 vl nhoi mau CO tim [5]) lin diu tien nim dilu tri tai khoa Tim mgch can thifp, Bfnh vifn Chp Riy tii thing 4/2015dlnthing7/2015.
Tat ci bfnh nhin nhoi mau co tim cip dupc dilu tri theo cic khuyin cio ve nhoi miu co tim cap ST chenh Ifn ciia Hpi Tim mgch chiu Au (ESC)2013[6]
2.2. Cdc tieu chuin trong nghien ciiu 2.2.L Xet nghifm sST2
Tit ca cic bfnh nhin dupc lam day du cic ^ : nghifm co ban ding thdi xet nghifm ndng dp sST2 tgi thdi dilm nghifn ciiu. Bfnh nhan sau khi xuat vifn se dupc theo ddi thfm 30 ngiy vl tinh trang dau ngyc, trieu chiing suy tim vi dip iing dilu trj thuic hay tir vong thdng qua tham khim tgi phdng kham hay Hfn hf difn thoai tryc tifp.
Miu mau dugc chiia trong Ip cd chit bao quin EDTA (Ethylene Di-amino-Tetra-Acetic acid) hogc heparin, quay ly tam trong 10 phut va tach huyet tuong ngay khi nhan mau miu, mau huyit tuong dugc trii d nhift dp -80°C (giff dugc 18 thing) vi dcri den khi nhgn du sd lupng benh nhan se tiln hanh phan ti'ch.
Thdi gian phin tich xet nghifm li 4 gid.
Dudng chuin dupc xiy dyng vdi 7 ning dp mau chuin trii dai tir 3,1 - 200ng/ml.
Gidi hgn phit hifn cua xet nghifm la 32pg/mL Difm cat cua sST2 theo cdng trinh nghifn ctru Framingham la 35ng/ml, diem cit niy cd Hfn quan den tu vong va tien trien suy tim.
2.3. Phuang phap nghien cmi Md t i cit ngang cd theo doi 30 ngay.
2.4. Xir ly s l lieu
Cic sd lieu nghifn cuu dugc xii 1;^ bing phin mem thdng ke SPSS for Windows phien bin 16.0, Cic biln sd djnh lugng cd phin phdi bmh thudng va dupc trmh bay dudi dang trung binh ± dp lech chuan. Cic bifn sd dinh tinh dupc trinh bay dirdi dgng trung vi, gii tri tli thilu, ^ i da.Cic bifn sd djnh >
tfnh dugc trmh biy dudi dgng ti If phin trim.Cac phep kifm dinh thong ke chinh dugc diing Ii:
* So sanh su khic biet giiia cic bifn so djnh lugng: Nfu cic bifn sfl cd phin phdi chuan thi dung * Phep kiem t - testva cd xet dfn sy khic bift vf phuang sal.
* Neu cic bifn so cd phan phdi khdng chuan thi diing phep kifm Mann-Whitney hoic chuyen vl phan phoi chuin va sir dyng phep kifm t -test.
* So sanh sy khic bift gitta cic biln sl djnh tinh: Phfp kilm Chi binh phuang (hifu chinh Fisher'sexact test neu can) dl kilm djnh sy khic bift tJ If giiia hai nhdm ciia biln so djnh tinh.
* Dinh gii moi lien quan vdi kit cyc lim sing bing ph6p kilm Wilcoxon.
* Vdi khoing tin c§y 95%, sy khic bift dugc xem la cd y nghia thing kf khi gia trj p < 0,05.
Tgp chi Y Dugc hgc - Truimg Dgi hgc Y Duyc Hui - So 32
3. KIET QUA
3.1. Sac dilm doi tugng nghifn cuu
Bang 3.L Phan dp Killip luc nhgp vifn PMnlSKillip
Dh|ip vifn DO Killip = I Do Killip > II
60-69 tuoi n=13 12(92,3)
I (7,7)
70-79 tuoi n=13 11(84,6) 2(15,4)
80-89 tu8i n=12 6 (50,0) 6 (50,0)
Gii trj P
<0,05 Cd su khic biet cd y nghta thdng ke d nhdm Killip = 1 va nhdm > II (p<0,05).
Bing 3.2. Thang dilm ngiiy co TIMI cho NMCT cip ST chfnh Ifn NJiom tuoi
n TIMI trung binh TIMI>8(n,%)
60-69 tuSi 13 6,46 ± 2,07
4 (30,8)
70-79 tuoi 13 7,23 ± 2,35
6 (46,2)
80-89 tuoi 12 10,75 ±2,05
11 (91,7)
P
< 0,001'
< 0,01 ' *
*Phep kiem ANOVA chinh xdc
**phep kiem Chi binh phuang
Gia tri TIMI trung binh tang din thep nhdm tufli (p<0,001)
Bang 3.3. Die diem cua nhdm bfnh nhin nghien ciiu Gia tri
Nam, n (%) Nu, n (%) Nhip tim trung binh Huyet ap tam thu Huyet ap tam truang BMI trung binh BNP (pg/ml) ECG Thanh tnroc, n (%) ECG Thanh dum, n (%) EF>40%,n(%) EF<40%,n(%)
60-69 tuoi 11(84,6) 2(15,4) 75,23 ±17,35 131,54± 19,19
78,46 ±15,19 22,53 ±2,49
109,5 (55,5-163,5)
5 (38,5) 8(61,5) 12(92,3) 1 (7,7)
70-79 tuoi 10(76,9)
3 (23,1) 76,08 ± 14,04 114,62± 19,41 68,08 ± 9,03 21,63 ±2,55
493,3 (87,0-769,3)
5 (38,5) 8(61,5) 11(84,6) 2 (15,4)
80-89 tuoi 8 (66,7) 4 (33,3) 80,0 ±17,07 110,83 ±21,08 68,33 ±10,29 20,15±3,37
533,0 (190,3-975,2)
7 (58,3) 5 (41,7) 5 (41,7) 7 (58,3)
P 0,57 0,74
<0,05 0,06 0,12
<0,05 0,52
<0,01 Cd sy khac biet cd y nghTa thong ke (p<0,01) d nhdm EF > 40% so vdi nhdm EF < 40% theo nhdm tudi. i
Bang 3.4. Kit qua chup va can thi?p mach vanh qua da co thuoc can quang D^c diem
Co chyp dpng mach vanh qua da Can thifp thanh cong DMV thii phgm Can thi?p DMV cap ciiu Can thi?p DMV chuong trinh Hf p > 2 nhinh DMV Hf p than chung DMV trii
i n(%) 37 (97,37) 36 (97,29) 18(48,6) 19 (51,4) 23 (62,2) 3 (8,1) T^* If cd chyp dpng mach vanh qua da li 97,37%
Tgp chl Y Dug-c hgc - Tru6ng Dgi hgc Y Dugc Hui - So 32 63
3.2. NSng dp sST2 trong nghien cuu va moi lien quan ciia sST2 vdi cac yeu to lam sang va cgn lam sang
Bang 3.5. Cac gia trj thdng kf cua ndng dp ST2 trong nghifn ciiu Dai lirong thong Ite
Trung binh ± dO Ifch chuin Gia tri tir phan vi
25%
50%
75%
Gia tri nho nhat Gia tri 16n nhat
Ket qua (Dg/ml) 47,75 ± 3,95
20,46 36,05 65,65 10,02 196,98 Trung binh chung vi dp Ifch chuan ciia ST2 la 47,75 ± 3,95 pg/ml
Bang 3.6. Moi lifn quan giiia ndng dp sST2 vi mpt so yeu td lam sing Yeu to lam sang
Gi6i; NO Nam Tang huyet ap Hut thuoc la Roi loan lipid man Dai thao duong Beo phi Dp Killip > n
sST2< 35 ng/ml n = 20 3 (15,0) 17 (85,0) 12 (60,0) 10(50,0) 17(85,0) 5 (25.0) 1 (0,05) 1 (0,05)
sST2> 35 ng/ml n = 18 6 (33,3) 12(66,7) 16(88,9) 8 (44,4) 15(83,3) . 2(11,1) 4 (22,22) 8 (44,44)
P 0,26
<0,05 0,73 0,88 0,41 0,17
<0,05 Phep kiem Fisher chinh xdc
C6 su khic bift khi phin nhom sST2< 35 ng/ml va sST2> 35 ng/ml 6 tang huyit ap (<0,05) va dg Killip > II
Bang 3.7. M6i Ii6n quan giiia n6ng dp sST2 va cic ylu t6 lam sang Yeu to lam sang
Tuoi BMI Thoi gian NMCT Nhip tim Huyet ap tam thu Huyit ap tam truong Diem nguy CO TIMI
sST2< 35 ng/ml n = 1 8 70,67 ±7,13 21,23 ±3,54 33,89 ±44,41 74,94 ±15,75 129,17± 16,47 78,06 ± 12,26
6,78 ±2,29 Phep kiem T student chinh xdc
sST2> 35 ng/ml n = 20 74,85 ±8,71 21,74 ±3,39 39,50 ±41,25 78,90 ± 16,20 110,25 ±21,67 68,5 ±10,89
9,25 ±2,77
P
<0,05 0,59 0,07 0,45
<0,05
<0,05
<0,001 Co sir khac bift 2 nhom phan theo sST2 doi vdi tu6i, huyit ip tam thu, huyit ip tam truong (p<0,05), TIMI(p<0,001)
T^p chi Y Dirge hfc - Trir&ng Dai hfc Y Ovtfz Hue - S6 32
Bang 3.8. Moi lien quan giifa nong dp sST2 va Gii tri c|n lam sang
Duong huyit (mg/dl) BUN (mg/dl) Creatinin (rag/dl) CKMB (U/L) Troponin I > I ng/ml BNP (pg/ml)
Phan suit tong miu that trii (%)
sST2< 35 ng/ml n = 20 118,78 ±71,38
13,21 (10,50 - 16,25)
1,03 ± 0,23 92,21 ±82,24
17(94,44) . 101,72 (64,62-174,12) 51,72 ±7,68
mpt so gii trj c|n lam sang sST2> 35 ng/ml
n = 18 152,15 ±74,69
20,51 (12,50-23,75)
1,12 ±0,21 151,19 ±82,69
18(90) 527,95 (152,52-1021,92)
41,95 ±8,75 P 0,45 0,07 0,21
<o,os
0,88
< 0,001
<0,01 Cd sy khac bift 2 nhdm phan theo sST2 dli vdi CKMB (p<0,05), BNP (p<0,001), phan suit tdng mau thit trai (p<0,01).
Bang 3.9. Tj- If tu vong vi suy tim sau 30 ngiy Ket cue lam sang sau 30 ngay
Tu vong Suy tim
n 2 ID
%
5,26 26,32 Ty le tir vong sau 30 ngay la 5,26%, ty le suy tim sau 30 ngay li 26,32%
Bang 3.10. Mii lien quan giifa kit cue lim sang va mpt sl ylu lo Bien khao sat
n ( % ) Gioi: Nam
.Nif Tang huyet ip Hut thuoc li Dai thio dutmg Roi loan lipid miu Beo phi Dp Killip = I Dp Killip > II Nh6i miu thanh tnioc Nhoi miu thinh duoi Hep 1 nhinh SMV Hep > 2 nhanh
Co s\r khic bift co y nghT
Ket cue (tir vong hoac suy tim) Co (n = 12)
8 (66,7) 4 (33,3) 10 (83,3) 4 (33,3) 9 (75,0) I (8,3) 2(16,7) 5(41,7) 7 (58,3) 8 (66,7) 4 (33,3) 10 (90,9) 1 (9,1) a thing ke giifa Killip dp 11
Khong ( n - 2 6 ) 21 (80,8)
5 (19,2) 18(69,2) 14(53,8) 23 (88,5) 4(15,4) 5 (19,2) 25 (96,2) I (3,8) 9 (34,6) 17 (65,4) 13 (50,0) 13 (50,0) a Killip dp II o nhom co v
Gia trj P 0,42 0,45 0,30 0,35 0,55 0,85
< 0,001
0,08
<0,05 a khong biln c6 (p<0,001), Hep 1 nhinh dOng mach vanh va hep > 2 nhinh dpng mach vanh (p<0,05).
T?p chf Y Dirgrc hgc - Trirfrng Dai hfc Y Duvc Hu^ - So 32 65
Bang 3.11. M6i tuong quan giifa ket cue lam sang va cic bien s6 lien tyc Bieu khao sat
Trung binh ±do If ch chuan Tuoi
Thai gian NMCT (gio) Dilm TIMI Nhip tim Huyit ap tira thu Huyit ap tam truang BMI
Glucose mau Creatinin CKMB BNP (pg/ml)
Phan suit tong mau thit trai<40%
Ket cue (tfr vong hoac suy tim) C6(n=12)
78,92 ± 6,5 55,5 ±4,8 9,7 ± 2,22 80,92 ±15,9 107,5 ±22,2 64,17 ±9,0 20,62 ±3,6 134,5 ±6,5 1,22±0,19 137,2 ±9,0 898,91 ± 174,4
36,4 ±5,3
Khong ( n - 2 6 ) 70,08 ± 7,4
28,2 ±3,5 6,8 ± 2,25 75,23 ±15,8 124,6 ±19,0 75,19 ±12,5 21,86 ±3,5 137,2 ±7,9 1,01 ±0,20 116,9 ±8,6 160,61 ± 136,2
51,2 ±6,3
Gia trj P
<0,00I
<0,05
<0,001 0,31
<0,02
<0,02 0,29 0,92
<0,01 0,51
< 0,001
< 0,001 Cd su khic biet cd y nghia thdng kf vf kit cyc xiu dli vdi creatinin mau (p<0,01), BNP (p<0,001), EF(p<0,001)
Bang 3.12. Moi lifn quan giira ndng dp sST2 va biln cd tim mgch Bien co tim mach
Tu vong Suy tim Tif vong hoac suy tim
sST2< 35 ng/ml ( n - 2 0 )
0(0) 2(10) 2(10)
sST2> 35 ng/ml (n = 18) 2(11,1) 8 (44,4) 10 (55,6)
P
<0,01
<0,001
<0,001 Co su khac biet c6 y nghia thing kS vl sST2<3S ng/ml va sST2> 35 ng/ml dli vai biln c6 tir vong (p<0,01), suy tim (p<0,001), tii vong hojc SUy tim (p<0,001)
Bang 3.13. Moi lien quan giifa sST2 va BNP v6i biln cl tim mach Bien co tim mach
Khong biln cl Co bien cl
sST2< 35 ng/ml v4BNP<500pg/ml
17(1) 0(0)
sST2>35hg/ml 1 sST2>35 ng/ml hoac BNP >500pg/ml | va BNP > 500pg/ml
8 (61,5) 1 (12,5) 5 (38,5) 1 7 (87,5)
P
< 0,001 Co sir khic bif 1 co y nghTa thing ke o 3 nhom phin theosST2 vi BNP (p<0,001).
4. BAN LUAN gj^ ^^^ j ^ Ig ^^^^^ ^^^^^ „ ^ ^ j^ong nghien cijru Tuoi trung binh ciia nhifngb^nh nhan tham gia ciia Shimpo M li 80,11%(8] vi ciia Sabatine S nghien ciiu la cao hon so voi hai nghien ciru cua tic la 79,28%[7]. NghiSn ciiu ciia chiing toi c« ty gia Shimpo (tuli trung binh la 58 ± 1,1)[8] vi tic 1? ting huyit ip, rii lo?n lipid miu, dii thao gii Sabatine S. (tuli taing binh li 58,8 ± 9,9)[7]. duimg cao hon so v6i hai nghien ciiu ciia hai tic Sv khic bi^t niy li do nghiSn ciiu ciia chiing toi gii nuiic ngoii. Nguyen nhin c6 the vi dli tupng nghidn ciiu ciJa chiing tli la nhiing b§nh nhin cao tuoi > 60 tuoi nen c6 ty 1? ylu t l nguy co tim mach cao hon.
Ning dp sST2 trung binh frong nghien cuu ciia chi thn nhjn nhiing dli tupng cao tuof (> 60 tuli)
nen CO tuoi trung binh cao hon.
Nghien ciru chung toi co ty 1? benh nhan nam la 76,32% thip hon so voi nghien ciiu cua hai tic
Tgp chi Y Duyc hgc - Trirfrng Dgi hgc Y Dirfc Hu^ - So 32
chiing tdi la 47,75± 3,95 ng/ml, trong dd gia trj nhd nhit la 10,02 ng/ml v i ldn nhit l i 196,98 ng/ml.
Trong nghifn cihi Framingliam thyc hifn v i o nam 2 0 1 2 tren ddi t u o n g nam va ntr trong dan so chung, trong dd nam cd 462 ngudi, gidi hgn nong dp sST2 tir 11-45 ng/ml, v i d 674 niJ cd gidi ban ndng dp sST2 tir 9-35 ng/ml. Trong nghifn cihi cua PRJDE, gia tri trung binh cua ndng dp sST2 d bfnh nhan suy tim m i t bii c i p la 42,7 ng/ml.
Hai cdng U-inh nghifn cuu tir 3 thii nghifm lam sang tren bfnh nhan nhdi mau c a tim c i p ST chfnh Ifn d u a ra c i c yfu td tifn d o i n b i l n co trong vdng 30 ngay sau nhoi mau c a tim d y a tren nong dp sST2[l],[9]. Shimpo v i cs d o ndng dp sST2 tren 810 benh nhan nhdi m i u c a tim c i p ST chenh len trong d o cd 362 benh n h i n t u nghien curu TIMI 14 va 448 benh nhan tir nghien cihi ENTIRE-TIMI 23, ndng dp sST2> 37 ng/ml cd gia trj tien luang bifn cd suy tim v i t u v o n g trong vdng 3 0 ngay sau nhdi m i u c a tim cap[8]; t u a n g t y n h u nghifn cuu cua chiing tdi> ndng dp sST2> 35 ng/ml cd y nghTa tien luong tir v o n g v i suy tim tien trien vdi p < 0,001. Ngoai ra, khi k i t hgrp ndng do sST2>
35 ng/ml vdi nhihig y l u t l khac n h u tang h u y i t ap, thang diem TIMI, p h i n dp Killipthi cang cd g i i tri tien luang trfn bfnh nhan nhdi m i u c a tim c i p ST chenh len.
Trong mpt cdng trinh nghien cihi n i m 2008 ciia J. Bartunekva cs, t h i y rang khi ket h a p ndng Ao BNP hogc NT-proBNP va sST2 trfn nhdm bfnh TAI L I E U 1. Brown AM Wu AHB, Clopton P, Robey JL, Hollander JE., (2007), ST2 in emergency department chest pain patients with potential acute coronary syndromes, Ann Emerg Med, 50, tr. 153-158.
2. Dhlllon OS Narayan HK, Khan SQ, Kelly D, Quinn PA, Squire IB, Davies JE, Ng LL., (2013), Pre- discharge risk stratification in unselected STEMI:
is there a role for ST2 or its natural ligand lL-33 when compared with contemporary risk markers, IntJCardiol, 167, U. 2182-2188.
3. Granger CB Goldberg RJ, Dabbous O, et al., (2003), Global Registry of acute coronary evenls investigators. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med, 163, U. 2345-2353.
4. J. Bartunek L. Delrue, F. van Durme et al., (2008),
nhan nay, n l u gia tri ciia ca hai nong dp deu tang tren m u c trung binh se tang nguy c a x i y ra bien CO (suy tim hogc tii vong) gap 10 lan[4], tuong t y cac nghien cihi Granger[6], Dhillon[2],[3]. Trong nghien cihi cua chung tdi cd 7 bfnh nhan cd nong dp sST2>35 ng/ml va BNP > 500 pg/ml, trong dd cd 2 ca tur vong va 5 ca tien triln sUy tim trong vdng 30 ngay, va sy khac bift d u a trfn g i i trj ciia sST2 va BNP d l i vdi b i l n co tim mgch' la cd y nghTa trfn phuong difn thdng ke vdi p<0,0001.
Nghien cdu nay l i b u d c d i u khao s i t ndng dp sST2 trfn ddi tuong nhoi mau c a tim c i p ST chfnh Ifn, c i n lam nghifn ciru vdi c a m i u Idn hon vdi thdi gian theo ddi d i i b a n df cd the ket luin gia tri irng dung cCia d i u i n sinh hoc mdi nay trfn tien lugng benh n h i n nhdi m i u c a tim cap ST chenh len cd can thiep mach vanh thi d i u .
5. K E T L U A N
sST2 > 35 ng/ml cd mdi lien quan vdi suy tim h o i c tic vong tim mgch vdi p<0,01.
B i l n CO tim mach hay gap d 3 nhdm theo thii tu lin lugt la sST2>35 ng/ml va B N P > 500 pg/ml, sST2> 35 ng/ml hogc BNP > 500 pg/ml, sST2 <
35 ng/ml v i BNP < 500 pg/ml.
6. » E X U A T
Trfn lim s i n g nfn diing phdi hgp B N P v i s S T 2 trong d i n h g i i nguy c a suy tim h o i c tii vong tim mach.
T H A M K H A O
Nonmyocardialproduction of ST2 protein m human hypertrophy and failure is related to diastolic load, Joumai of the American College of Cardiology, 52(25), U. 2166-2174.
5. Kristian Thygesen Joseph S. Alpert, Allan S. Jaffe., (2012), Third universal definition ofmyocardiai infarction, European Heart Journal, 33, tr. 2 5 5 1 - 2567.
6. Patrick T. O'Gara Frederick G. Kushner, Deborah D. Ascheim (2013), ACCF/AHA Guideline for the Management ofST-Elevation Myocardial Infarction, A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, Circulation, 127.
7. Sabatine MS Morrow DA, Higgins ,LJ, MacGillivray C, Guo W, Bode C, Rifaj N, Cannon
Tgp chi Y DUQC hQC - Truimg Dgi hpc Y Du'«yc H u i - S l 32
CP, Gerszten RE, Lee RT., (2008 ), Complementary roles for biomarkers of biomechanical strain ST2 and N-lerminal pro-hormone B-type natriuretic peptide in patients with ST-elevation myocardial infarction. Circulation, 117, tr. 1936-1944.
, Shimpo M Morrow DA,- Weinberg EO, Sabatine MS, Murphy SA, Anttnan EM, Lee RT, (2004), Serum levels of the mterleukin-I receptor family
member ST2 predict mortality and clinical outcome in acute myocardial irtfarction, Circulatton, 109, tr 2186-2190.
Weinberg EO Shimpo IA, De Keulenaer GW.
MacGillivray C, Tominaga S, et al., (2002), Expression and regulation ofST2, an interleukin-1 receptor famify member, m cardiomyocytes and myocardial infarction.
Circulation, 106, tr. 2961-2966.
Tgp chi Y Duyc hpc - Tnrimg figi hpc Y Dup'c Hue - S l 32
