慢性心衰患者血清尿酸水平的动态变化及其临床意义

The Dynamic Changes of Serum Uric Acid in Patients with Congestive Heart Failure and Its Clinical Significance

目的:探讨慢性心衰患者血清尿酸水平的变化规律及临床意义。方法:比较慢性心衰(58例)不同心功能状态下的尿酸水平,对32例心衰控制前后的尿酸水平、左室舒张末径(LVEDD)≥60 mm(36例)和<60 mm(22例)患者的尿酸水平、入院时未用利尿剂及正在服用利尿剂患者的尿酸水平、BUN>7.5(24例)和≤7.5 mmol/L(34例)患者的尿酸水平进行比较。结果:心功能Ⅱ、Ⅲ、Ⅳ级的尿酸水平分别为(312±41)、(434±91)、(585±156)mmol/L,Ⅳ级心功能者尿酸水平明显高于Ⅲ级者(P<0.01);心衰控制前后尿酸水平分别为(629±232)和(403±128)mmol/L,心衰控制后尿酸水平明显降低(P<0.01);左室舒张末径≥60 mm者尿酸水平[(547±153)mmol/L]明显高于<60 mm者[(389±115)mmol/L](P<0.01);入院时服与未服利尿剂者尿酸分别为(524±105)和(516±126)mmol/L,差异无统计学意义(P>0.05);BUN>7.5与≤7.5 mmol/L者尿酸水平分别为(545±178)和(459±167)mmol/L,差异无统计学意义(P>0.05)。结论:慢性心衰患者尿酸水平增高,增高程度与心衰严重程度有关,而独立于服用利尿剂及肾功能不全;可以认为血清尿酸水平是反映心衰患者病情严重程度的一个指标。

Objective： To assess the rules and clinical significance of increased serum uric acid in patients with heart failure. Methods： The studied population consisted of 58 patients with heart failure with New York Heart Association（NYHA） functional class Ⅱ- Ⅳ Serum uric acid was assessed. The patients were divided into different groups according to the severity of heart failure, left ventricular end-diastolic diameter（LVEDD）（60 ram）, diuretic therapy and blood urea nitrogen （BUN） （7. 5 mmol/L）. Results：The concentration of serum uric acid in patients at NYHA functional class Ⅱ,Ⅲ,Ⅳ were （312±41）,（434±91）and （585±156）mmol/L respectively. The concentration of serum uric acid increased significantly in patients with cardiac function class Ⅳ as compared to those with class Ⅲ （P〈0.01）. Serum uric acid were （629±232）/（403±128）mmol/L before/after stabilization of heart failure （P 〈 0. 01）. It was much higher in Patients whose LVEDD≥60 mm as compared to those LVEDD〈60 mm. There was no differences between the patients who received diuretics or not （P〉0.05）. BUN also did not influence serum uric acid. Conclusion：The increased serum uric acid may be associated with deterioration of heart failure and independent of diuretics therapy or renal function insufficiency. It is a predictor of the severity of heart failure.