OBJECTIVES: Accurate diagnosis and prognostic assessment of heart failure are crucial for improving patients' quality of life. This study aims to investigate the clinical value of serum soluble growth stimulation expressed gene 2 protein (sST2) levels in patients with heart failure, with and without obesity/overweight. METHODS: Serum samples were collected from patients with heart failure admitted to the Second Xiangya Hospital, Central South University, between October 2023 and March 2024. Participants were divided into three groups: heart failure with obesity/overweight group (n=71), heart failure without obesity/overweight group (n=62), and healthy control group (n=60). Serum sST2 levels were measured using a dry fluorescence immunoassay. Differences in sST2 concentrations among groups were analyzed, and the clinical value of sST2 and related metabolic indicators in different subgroups of patients with heart failure was evaluated. RESULTS: Serum levels of sST2, N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT), and blood glucose (GLU) were significantly higher in patients with heart failure than in healthy controls, whereas total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were significantly lower (all P<0.05). Serum sST2 levels were significantly positively correlated with NT-proBNP, cTnT, GLU, and tricuspid regurgitation velocity (TRV), and significantly negatively correlated with HDL-C and left ventricular ejection fraction (LVEF) (all P<0.05). The diagnostic value of sST2 for heart failure was significantly higher in patients without obesity/overweight than in those with obesity/overweight [area under the curve (AUC): 0.803 vs 0.696]. sST2 demonstrated good diagnostic performance in patients with heart failure with reduced ejection fraction (HFrEF; LVEF≤40%) (AUC=0.807) and in patients without overweight or obesity with HFrEF (AUC=0.802) (both P<0.001). The combined use of sST2, body mass index (BMI), HDL-C, and age significantly improved the diagnostic performance for HF (AUC=0.983). CONCLUSIONS: sST2 has substantial diagnostic value in patients with heart failure without overweight or obesity, but limited value in patients with overweight or obesity. Combined assessment of sST2, age, BMI, and HDL-C significantly enhances its diagnostic utility for heart failure. This model may be applicable for rapid heart failure screening in primary healthcare settings; however, prospective studies are required for further validation. 目的: 对心力衰竭进行准确的诊断和预后评估对于改善患者生活质量至关重要。本研究旨在探讨血清可溶性生长刺激表达基因2(soluble growth stimulation expressed gene 2，sST2)水平在是否合并肥胖/超重的心力衰竭患者中的临床应用价值。方法: 收集2023年10月至2024年3月中南大学湘雅二医院收治的心力衰竭患者的血清样本。将研究对象分为心力衰竭合并肥胖/超重组(n=71)、心力衰竭不合并肥胖/超重组(n=62)和健康对照组(n=60)。采用免疫荧光干式定量法测定血清sST2水平，分析不同组的sST2水平差异，评估sST2及相关代谢指标在不同心力衰竭患者中的临床应用价值。结果: 心力衰竭患者sST2、N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide，NT-proBNP)、心肌肌钙蛋白T(cardiac troponin T，cTnT)和空腹血糖的血清水平均显著高于健康对照组，总胆固醇(total cholesterol，TC)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol，HDL-C)和低密度脂蛋白胆固醇(low-density lipoprotein cholesterol，LDL-C)的血清水平低于健康对照组(均P<0.05)。sST2水平与NT-proBNP、cTnT、血糖和三尖瓣反流流速(tricuspid regurgitation velocity，TRV)均呈显著正相关，与HDL-C和左室射血分数(left ventricular ejection fraction，LVEF)均呈显著负相关(均P<0.05)。sST2用于诊断心力衰竭在不合并肥胖/超重患者中的价值显著高于在合并肥胖/超重患者中的价值[曲线下面积(area under the curve，AUC):0.803 vs 0.696];sST2针对射血分数降低型心力衰竭(heart failure with reduced ejection fraction，HFrEF;LVEF≤40%)人群(AUC=0.807)和不合并超重/肥胖的HFrEF人群(AUC=0.802)具有较高的诊断价值(均P<0.001);联合应用sST2、体重指数(body mass index，BMI)、HDL-C及年龄能显著提高对心力衰竭发病的诊断价值(AUC=0.983)。结论: sST2对于非肥胖心力衰竭患者具有较高诊断价值，但在肥胖患者中价值有限。sST2与年龄、BMI和HDL-C联合检测能显著提高其对心力衰竭的诊断价值，该模型适用于基层医疗场景的快速心力衰竭筛查，但需前瞻性研究验证。.