摘要
目的探讨老年慢性心力衰竭(chronic heart failure,CHF)患者同型半胱氨酸(Hcy)水平与N末端B型利钠肽原(N-terminal-pro-B-type natriuretic peptide,NT-proBNP)、左心室结构和功能的相关性。方法我院心脏科住院治疗老年CHF患者84例作为CHF组,依据纽约心脏病学会(NYHA)心功能分级标准将CHF组分为心功能Ⅱ级34例,Ⅲ级38例,Ⅳ级12例;纳入同期在我院健康体检者78例作为对照组。检测两组患者Hcy、NT-proBNP,运用彩色多普勒超声进行左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)测定,进行比较及相关性分析。CHF组患者入院后给予常规治疗基础上加用重组人脑利钠肽(recombinant human brain natriuretic peptide,rhBNP)抗心力衰竭治疗,先给予1.5μg/kg负荷量,继之以0.01μg·k-1·min-1静脉持续泵入72小时。在保证血压的情况下,维持治疗7天,比较治疗前后CHF组患者Hcy、NT-proBNP,LVEDD及LVEF。结果1CHF组Hcy、NTproBNP均较对照组明显升高(P<0.05);2心功能Ⅳ级组Hcy、NT-proBNP水平最高,与心功能Ⅱ、Ⅲ组比较有统计学意义(P<0.05);心功能Ⅲ级组Hcy、NT-proBNP水平比心功能Ⅱ级组增高(P<0.05);3CHF症状改善后血清Hcy、NT-proBNP水平较治疗前明显下降(P<0.05);而LVEDD、LVEF治疗前后无明显变化(P>0.05);4CHF组血清Hcy水平与NT-proBNP、LVEDD呈正相关(r=0.586,r=0.284,P<0.05),与LVEF呈负相关(r=-0.492,P<0.05)。结论老年CHF患者Hcy水平随着CHF程度的加重而相应升高,与NT-proBNP、LVEDD及LVEF有良好的相关性,可以反映CHF严重程度。
Objective To investigate the relation between homocysteine（Hcy）,N-terminal B-type natriuretic peptide,structure and function of the left ventricular in elderly patients with chronic heart failure（CHF）.MethodsCHF group included 84 elderly patients with CHF,who were hospitalized in Cardiology at Xuanwu Hospital.According to the criterion of New York Heart Association（NYHA）class,CHF group was divided into three groups,cardiac function gradeⅡincluded 34 cases,grade Ⅲ 38 cases,grade Ⅳ 12 cases.At the same time,control group enrolled 78 cases of healthy people,who had health check in the hospital.Hcy and NT-proBNP were detected,the left ventricular end-diastolic diameter（LVEDD）,left ventricular ejection fraction（LVEF）were measured in two groups using color Doppler ultrasound.CHF group was treated with routine therapies,and recombinant human brain natriuretic peptide（rhBNP）,first given 1.5μg/kg loading dose,and then intravenous pump 0.01μg·k-1·min-1 for72 h.After treatment for 7days,the clinical data and laboratory results were collected.The data of two groups were compared and correlations were analyzed.Results 1Hcy and NT-proBNP in CHF group were significantly higher than those of control group（P〈0.05）;2 Hcy and NT-proBNP were the highest in group of cardiac function Ⅳas compared with the groups of heart function Ⅱand Ⅲ（P〈0.05）;and Hcy and NT-proBNP in group of cardiac function Ⅲ were higher than those of cardiac functionⅡ group（P〈0.05）;3Hcy and NT-proBNP sharply decreased after the heart failure symptoms improved（P〈0.05）.However,there were no significant differences in LVEDD,and LVEF before and after the treatment（P〉0.05）.4There were positive correlation between the level of Hcy and NTproBNP（r=0.586,P〈0.05）,LVEDD（r=0.284,P〈0.05）,and the level of Hcy was negatively correlated with LVEF（r=-0.492,P〈0.05）.Conclusion The level of Hcy is increasing with the aggravating of heart failure and it has great relativity with NT-proBNP,LVEDD and LVEF,so it can reflect the severity of heart failure.
出处
《临床荟萃》
CAS
2016年第6期644-648,共5页
Clinical Focus
基金
国家高技术研究发展计划(863计划)资助项目(2012BAI37B03)
