2026 年第 4 期 第 21 卷

血清可溶性生长刺激表达基因2蛋白水平在急性B型主动脉夹层预后评估中的价值及与CT特征的相关性

Value of serum soluble growth stimulation-expressed gene 2 protein level in prognostic evaluation of acute type B aortic dissection and its correlation with CT features

作者：毛文星李明慧潘昌王高峰

英文作者：Mao Wenxing Li Minghui Pan Chang Wang Gaofeng

单位：南京医科大学附属南京医院（南京市第一医院）心血管内科，南京210000

英文单位：Department of Cardiovascular Medicine Nanjing Hospital Nanjing Medical University (Nanjing First Hospital) Nanjing 210000 China

关键词：急性B型主动脉夹层；可溶性生长刺激表达基因2蛋白；多层螺旋CT

英文关键词：AcutetypeBaorticdissection;Solublegrowthstimulation-expressedgene2protein;Multi-slicespiralCT

• 摘要：

• 目的 探究可溶性生长刺激表达基因2蛋白（sST2）与急性B型主动脉夹层（ATBAD）患者多层螺旋CT（MSCT）特征及预后的关系。方法 选取2021年7月至2023年7月南京市第一医院经MSCT确诊并收治的ATBAD患者共135例，根据2年随访结果分为预后良好组（n=105）和预后不良组（n=30）。收集患者临床资料、血清生物标志物及MSCT影像特征。二元Logistic回归分析血清sST2水平与ATBAD患者MSCT特征的相关性，LOWESS分析sST2水平与炎症因子的非线性关系，Cox回归分析预后不良的影响因素。受试者工作特征（ROC）曲线评估ATBAD患者血清sST2水平对患者预后的预测价值。限制性立方样条及阈值效应分析sST2水平与预后不良风险的剂量-反应关系。使用逐步回归法和Bootstrap法检验分析炎症因子在sST2与预后之间的中介效应。采用Kaplan-Meier法和Log-rank检验分析血清sST2水平对患者2年生存率的影响。结果 135例ATBAD患者的MSCT主要特征为主动脉扩张（77例，57.0%）、出现真假腔（58例，43.0%）和内膜撕破（55例，40.7%）。预后不良组患者血清内sST2、D-二聚体、C反应蛋白、心肌肌钙蛋白I（cTnI）、白细胞介素6（IL-6）和肿瘤坏死因子α（TNF-α）水平均高于预后良好组，而抗炎因子IL-4水平低于预后良好组（均P＜0.05）。预后不良组主动脉扩张、主动脉夹层破口、出现真假腔、血栓扩散和内膜撕破发生率均高于预后良好组，差异均有统计学意义（均P＜0.05）。二元Logistic回归显示，sST2与主动脉扩张、夹层破口、真假腔和血栓扩散呈正相关（均比值比＞1，P＜0.05）。LOWESS分析显示ATBAD患者血清内sST2水平与D-二聚体、C反应蛋白、cTnI、IL-4、IL-6、TNF-α水平均存在非线性关系。Cox回归显示sST2、D-二聚体、C反应蛋白、cTnI、IL-6、TNF-α是ATBAD患者预后不良的独立危险因素，IL-4为保护因素（均P＜0.05）。ROC曲线显示sST2预测ATBAD患者预后的曲线下面积为0.814（95%置信区间：0.779～0.854）。限制性立方样条分析显示sST2水平与ATBAD患者预后风险存在非线性关系（P＜0.001），当sST2水平＞29.64 μg/L时，预后不良风险随着sST2水平上升而逐渐升高。中介效应分析显示，IL-4、IL-6、TNF-α在sST2水平与ATBAD患者预后不良之间具有中介调控作用。生存曲线显示sST2浓度较低的患者2年生存率较高（Log-rank P＜0.05）。结论 血清sST2水平与ATBAD患者MSCT所示的主动脉扩张、夹层破口、血栓扩散等特征呈正相关，还与ATBAD患者预后不良风险呈正相关，可作为评估ATBAD患者的重要生物标志物，为临床治疗提供重要依据。

• Objective To investigate the relationship between soluble growth stimulation-expressed gene 2 protein (sST2) and multi-slice spiral CT (MSCT) features and prognosis in patients with acute type B aortic dissection (ATBAD). Methods A total of 135 ATBAD patients diagnosed and admitted to Nanjing First Hospital by MSCT from July 2021 to July 2023 were selected and divided into the good prognosis group (105 cases) and poor prognosis group (30 cases) according to the 2-year follow-up results . The clinical data, serum biomarkers and MSCT imaging features of the patients were collected. Binary Logistic regression analysis was used to explore the correlation between serum sST2 level and MSCT features of ATBAD patients, LOWESS analysis was adopted to analyze the nonlinear relationship between sST2 level and inflammatory factors, and Cox regression analysis was used to identify the influencing factors of poor prognosis. Receiver operating characteristic (ROC) curve was applied to evaluate the predictive value of serum sST2 level for the prognosis of ATBAD patients. Restricted cubic spline and threshold effect analysis were used to explore the dose-response relationship between sST2 level and the risk of poor prognosis. Stepwise regression and Bootstrap methods  were used to test and analyze the mediating effect of inflammatory factors between sST2 and prognosis. Kaplan-Meier method and Log-rank test were used to analyze the effect of serum sST2 level on the 2-year survival rate of patients. Results The main MSCT features of the 135 ATBAD patients were aortic dilatation (77 cases, 57.0%), true and false lumens (58 cases, 43.0%) and intimal tear (55 cases, 40.7%). The serum levels of sST2, D-dimer, C-reactive protein, cardiac troponin I (cTnI), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the poor prognosis group were significantly higher than those in the good prognosis group, while the level of anti-inflammatory factor IL-4 was significantly lower (all P＜0.05). The incidences of aortic dilatation, aortic dissection rupture, true and false lumens, thrombus spread and intimal tear in the poor prognosis group were significantly higher than those in the good prognosis group (all P＜0.05). Binary Logistic regression showed that sST2 was positively correlated with aortic dilatation, dissection rupture, true and false lumens and thrombus spread (all odds ratio＞1, P＜0.05). LOWESS analysis revealed a nonlinear relationship between serum sST2 level and the levels of D-dimer, C-reactive protein, cTnI, IL-4, IL-6 and TNF-α in ATBAD patients. Cox regression indicated that sST2, D-dimer, C-reactive protein, cTnI, IL-6 and TNF-α were independent risk factors for poor prognosis in ATBAD patients, and IL-4 as a protective factor (all P＜0.05). ROC curve showed that the area under the curve of sST2 for predicting the prognosis of ATBAD patients was 0.814 (95% confidence interval: 0.779-0.854). Restricted cubic spline analysis demonstrated a nonlinear relationship between sST2 level and prognostic risk in ATBAD patients (P＜0.001), and when the sST2 level was ＞29.64 μg/L, the risk of poor prognosis increased gradually with the elevation of sST2 level. Mediation effect analysis showed that IL-4, IL-6 and TNF-α had a mediating regulatory effect between sST2 level and poor prognosis in ATBAD patients. Survival curve indicated that patients with lower sST2 concentration had a higher 2-year survival rate (Log-rank P＜0.05). Conclusion Serum sST2 level is positively correlated with MSCT features such as aortic dilatation, dissection rupture and thrombus spread in ATBAD patients, and also positively correlated with the risk of poor prognosis in ATBAD patients. It can serve as an important biomarker for evaluating ATBAD patients and provide an important basis for clinical treatment.