慢性心力衰竭患者血清肌钙蛋白I与心肌重构的相关性研究

Association between serum cardiac troponin I and myocardial remodeling in patients with chronic heart failure

目的研究慢性心力衰竭(CHF)患者血清心肌肌钙蛋白I(cTnI)与心肌重构的相关性。方法入选失代偿性CHF患者120例,根据血清cTnI浓度水平分为cTnI正常组(n=80)和cTnI升高组(n=40)。以左心房直径(LAd)、左心室直径(LVd)、室间隔厚度(IVS)、左室后壁厚度(LVPW)作为心脏结构改变指标,左室射血分数(LVEF)、E峰和A峰比值(E/A值)作为心脏功能指标,对上述指标进行组间比较。结果与cTnI正常组相比,cTnI升高组的LAd、LVd显著增高(P<0.05);而IVS、LVPW、LVEF、E/A值显著降低(P<0.05)。相关分析显示血清cTnI含量与LAd、LVd呈正相关(P<0.05),与IVS、LVPW、LVEF、E/A呈负相关(P<0.05),经性别、心衰病史、心功能分级与药物治疗校正后,上述相关性仍然存在,并具有统计学意义。进一步行多因素logistic回归分析,结果显示LAd、LVd和心衰病史与cTnI升高呈正相关;而血管紧张素转换酶抑制剂(ACEI)治疗与cTnI升高呈负相关。结论血清cTnI浓度与心衰患者心肌重构及心功能具有显著相关性,此相关性可不依赖于年龄、性别、心衰病史、NYHA心功能分级和药物治疗而独立存在。监测心力衰竭患者血清cTnI浓度并采取相应的措施降低血清cTnI水平,对临床治疗和预防心力衰竭进展具有重要意义。

Objective To investigate the association between serum cardiac troponin I （cTnI） and cardiac function/structure in patients with chronic heart failure. Methods One hundred and twenty patients with decomponsated chronic heart failure were included. The patients were divided into cTnI normal group （ cTnIn; n = 80） and cTnI elevated group （ cTnIe; n = 40 ）. Systolic dimension of the left atrium （ LAd）, the maximal width of the left ventricle （ LVd）, the thickness of the interventricular septum （IVS） and posterior wall （LVPW） during diastole, left ventricle ejection fraction （LVEF）, E and A wave velocities ratio （E/ A） were determined. Bivariate correlation analysis was applied to show the correlation of serum cTnI level with above indices. Partial correlation analysis was performed followed by multivariate logistic regression. Results LAd and LVd dimensions were significantly higher （ P 〈 0. 05 ）, IVS, LVPW, LVEF and E/A ratio were significantly lower（ P 〈 0. 05 ） in cTnIe group than in cTnIn group. Moreover, serum cTnI was positively correlated with LAd, LVd, and inversely correlated with IVS, LVPW, LVEF and E/A ratio （P 〈0. 05）. The correlation persistent after adjustion with sex, history of heart failure, NYHA functional class and treatment. In multivariate modeling, cTnI was positively associated with LAd, LVd and the history of heart failure, and negatively related with the treatment with angiotensin-converting enzyme inhibitor. Conclusion Serum cTnI correlated with cardiac structure and function. Intensively serum cTnI monitoring and suitable therapy strategy may be helpful to attenuate the cardiac remodeling in patients with chronic heart failure.