急性心力衰竭短期预后生物标志物研究： 现状、局限与未来方向

Biomarkers for Short-Term Prognosis in Acute Heart Failure: Current Status, Limitations, and Future Directions

摘要: 急性心力衰竭(AHF)起病急骤、病情演变迅速，患者在住院期及出院后早期面临较高的死亡和再住院风险，精准的短期预后评估对于优化临床决策至关重要。利钠肽和心肌肌钙蛋白等传统生物标志物主要反映容量负荷和心肌损伤，构成了当前风险评估的核心框架，但其对炎症、纤维化、系统性应激等多维病理机制覆盖不足。近年来，可溶性ST2 (sST2)、生长分化因子-15 (GDF-15)和心型脂肪酸结合蛋白(H-FABP)等新型生物标志物分别从心肌应激与重构、系统性应激与整体疾病负担、早期持续性心肌损伤等维度提供了补充信息，显示出改善短期风险分层的潜力。在此基础上，整合多病理通路的多标志物联合检测策略较单一指标更能反映AHF的生物学异质性，初步研究证实其具有额外的预后判别能力。然而，该领域仍存在研究设计异质性大、检测与阈值标准化不足、终点定义不统一及独立增量价值证据有限等局限。未来研究应推进多中心前瞻性设计、标准化检测与解释框架、基于表型的精准分层，并验证标志物导向的管理策略能否切实改善患者结局，从而推动AHF短期预后评估从单一指标探索走向多维度整合与临床转化。

Abstract: Acute heart failure (AHF) has an abrupt onset and a rapidly evolving clinical course. Patients face high risks of death and rehospitalization during hospitalization and in the early post-discharge period, making accurate short-term prognostic assessment crucial for optimizing clinical decision-making. Traditional biomarkers such as natriuretic peptides and cardiac troponins primarily reflect volume overload and myocardial injury, forming the core of current risk assessment frameworks, yet they provide insufficient coverage of multidimensional pathophysiological mechanisms including inflammation, fibrosis, and systemic stress. In recent years, novel biomarkers such as soluble ST2 (sST2), growth differentiation factor-15 (GDF-15), and heart-type fatty acid-binding protein (H-FABP) have offered complementary information from the dimensions of myocardial stress and remodeling, systemic stress and overall disease burden, and early or persistent myocardial injury, respectively, showing potential to improve short-term risk stratification. Furthermore, multi-marker combined detection strategies that integrate multiple pathological pathways can better reflect the biological heterogeneity of AHF than single markers, with preliminary studies demonstrating additional prognostic discriminatory capacity. However, this field still faces limitations including high heterogeneity in study designs, insufficient standardization of assays and thresholds, inconsistent endpoint definitions, and limited evidence for independent incremental value. Future research should advance multicenter prospective designs, standardized assay and interpretation frameworks, phenotype-based precise stratification, and verification of whether biomarker-guided management strategies can truly improve patient outcomes, thereby promoting the transition of short-term prognostic evaluation in AHF from single-marker exploration to multidimensional integration and clinical translation.