老年冠心病慢性心力衰竭患者血浆同型半胱氨酸与心脏功能的相关性

摘要

目的 观察老年冠状动脉粥样硬化性心脏病(冠心病)慢性心力衰竭(chronic heart failure,CHF)患者血浆同型半胱氨酸(Hcy)的水平与心脏功能的相关性.方法 选择老年冠心病62例作为冠心病组,根据美国纽约心脏病学会(NYHA)心功能分级标准,分为CHF组(42例)和心功能代偿组(20例),其中CHF组又分为NYHAⅡ级组和NYHAⅢ~Ⅳ级组;选择同期体检健康的老年人20例作为对照组.比较各组血浆Hcy、N末端B型脑钠肽前体(NT-proBNP)、左室射血分数(LVEF)和左室舒张末期内径(LVEDD)变化,分析血浆Hcy水平与NT-proBNP、LVEF和LVEDD的相关性.结果 与对照组比较,代偿组及CHF组血浆Hcy、NT-proBNP水平及CHF组LVEDD均升高,且CHF组LVEF降低,差异均有统计学意义(P<0.05);与代偿组比较,CHF组血浆Hcy、NT-proBNP水平及LVEDD均升高,LVEF降低,差异均有统计学意义(P<0.05).NYHAⅡ级组与NYHAⅢ~Ⅳ级组血浆Hcy及NT-proBNP水平比较差异均有统计学意义(P<0.05).老年CHF患者血浆Hcy水平与NT-proBNP、LVEDD呈正相关,与LVEF呈负相关.结论 老年冠心病CHF患者血浆Hcy水平明显升高,且与NT-proBNP、LVEF和LVEDD呈明显相关性,可作为反映心力衰竭严重程度的参考指标.%Objective To observe correlation between serum homocysteine (Hcy) levels and cardiac function in chronic heart failure ( CHF) elderly patients with coronary atherosclerotic heart disease ( CAD) . Methods A total of 62 eld-erly patients with CAD were selected as CAD group, and the patients were divided into CHF subgroup (n=42) and cardiac function compensatory subgroup (n=20) according to cardiac function classification criteria from New York Heart Association ( NYHA) , and then CHF subgroup were divided into NYHA grade Ⅱ subgroup and NYHA grade Ⅲ-Ⅳ subgroup; other 20 healthy elderly patients taking medical examination at the same period were selected as control group. Changes of serum Hcy, n-terminal pro-b-type natriuretic peptide ( NT-proBNP) , left ventricular ejection fraction ( LVEF) and left ventricular end di-astolic dimension ( LVEDD) were compared, and correlations between serum Hcy levels with NT-proBNP, LVEF and LVEDD were analyzed in all groups and subgroups. Results Compared with those in control group, serum Hcy and NT-proBNP levels in compensatory and CHF subgroups and LVEDD level in CHF subgroup were significantly increased, while LVEF level in CHF subgroup was decreased (P <0. 05). Compared with those in compensatory subgroup, serum Hcy, NT-proBNP and LVEDD levels were significantly increased, while LVEF level was significantly decreased in CHF subgroup (P <0. 05). There were significant differences in serum Hcy and NT-proBNP levels between NYHA grade Ⅱ and NYHA gradeⅢ-Ⅳsub-groups (P<0. 05). Serum Hcy level in CHF elderly patients with CAD were positively correlated with NT-proBNP and LVEDD levels, and negatively correlated with LVEF level. Conclusion Serum Hcy level in CHF elderly patients with CAD significantly increases, and it is significantly correlated with NT-proBNP, LVEF and LVEDD levels, which can be used as an index in reflection of severity of heart failure.