扩张型心肌病慢性心衰患者的血清同型半胱氨酸与QRS波时限的相关性研究

摘要

目的 探讨在扩张型心肌病(扩心病)慢性心力衰竭患者中血清同型半胱氨酸(HCY)水平与QRS波时限的相关性.方法纳入扩心病慢性心衰患者70例,按照美国纽约心脏病协会(NYHA)心功能分级分为心功能Ⅱ级组(n=23)、Ⅲ级组(n=25)、Ⅳ级组(n=22),同期纳入无慢性心衰的扩心病患者30例为扩心病对照组,健康体检者30例为健康对照组.测定所有入选对象血清HCY水平和脑钠肽(BNP)浓度,QRS波时限,彩色超声多普勒测量左室舒张末期内径(LVEDd)和左室射血分数(LVEF),比较不同组别血清HCY水平及QRS波时限的差异,观察扩心病心衰患者血清同型HCY水平与QRS波时限与心功能分级、BNP、LVEDd、LVEF关系.结果①扩心病心衰组血清HCY水平高于其他两组,且随心衰程度加重而升高;②QRS波时限在扩心病心衰组显著长于其他两组,并随心衰程度加重而延长;③扩心病心衰组QRS波时限延长与血清HCY、BNP、LVEDd均呈正相关,与LVEF呈负相关.结论心电图QRS波时限延长对评价扩心病患者的心脏结构和功能损害程度具有临床意义,与血清HCY结合对扩心病心衰患者的预后具有预测价值.%Objective To investigate the correlation between the level of serum homocysteine ( HCY ) and QRS duration in patients with chronic heart failure ( CHF ) secondary to dilated cardiomyopathy. Methods The patients ( n =70 ) were selected as group of CHF secondary to dilated cardiomyopathy and then divided into three sub—groups including grade II group ( n=23 ) , grade III group ( n=25 ) and grade IV group ( n=22 ) according to class of New York Heart Association ( NYHA-class ) , and at the same time the patients ( n=30 ) without CHF were selected as control group and healthy subjects ( n=30 ) were selected as healthy group. The levels of serum HCY and brain natriuretic peptide ( BNP ) and QRS duration were detected in all subjects. The changes of left ventricular end—diastolic inner dimension ( LVEDd ) and left ventricular ejection fraction ( LVEF ) were detected with color Doppler ultrasound. The level of HCY and QRS duration were compared among all groups, and the relationship between HCY and QRS duration, NYHA-class, BNP, LVEDd and LVEF was observed. Results ①The level of HCY was higher in group of CHF secondary to dilated cardiomyopathy than that in other two groups, and increased along with the aggravation of heart failure. ②QRS duration was significantly longer in group of CHF secondary to dilated cardiomyopathy than that in other two groups, and was extended along with the aggravation of heart failure. ③The prolonged QRS duration was positively correlated to HCY, BNP and LVEDd, and negatively correlated to LVEF in group of CHF secondary to dilated cardiomyopathy. Conclusion The prolonged QRS duration is significant to the evaluation of heart structure and functional damage in the patients with CHF secondary to dilated cardiomyopathy, and the combination of QRS duration and serum HCY level can be used for predicting patients' prognosis.