慢性收缩性心力衰竭患者血尿酸浓度改变及其与氧化应激的关系研究

Relationship between the level of uric acid and oxidative stress in patients with chronic systolic heart failure

目的研究慢性收缩性心力衰竭（CSHF）患者血尿酸（UA）浓度改变与心功能及谷胱甘肽抗氧化系统的关系。方法选择2006年6月至2007年3月109例患者，根据有无器质性心脏病及心功能情况分为CSHF组81例，对照组28例，CSHF组又按纽约心脏病协会（NYHA）心功能分级分为心功能Ⅱ级组28例，心功能Ⅲ级组28例，心功能Ⅳ级组25例。所有患者均于入院第2天采空腹静脉血，应用酶循环法测定血浆还原型谷胱甘肽（GSH）、氧化型谷胱甘肽（GSSG）浓度，并利用Nemst公式计算氧化还原电位Eh值。结果CSHF组患者血UA浓度[（499．09±168．04）umol／L]较对照组[（310．54±99．92）umol／L]明显升高（P〈0．01），且随着心功能分级的增加而升高，与LVEF呈负相关（r=-0．247，P=0．026），与左室舒张末期内径（LVEDD）呈正相关（r=0．266，P=0．016）。血UA浓度与血浆C．SH浓度呈负相关（r=-0．328，P=0．003），与血浆GSSG浓度呈正相关（r=0．244，P=0．028），与Eh值呈正相关（r=0．309，P=0．005）。结论CHF时血UA浓度升高，且与心功能分级、LVEF、LVEDD存在相关眭，可作为反映收缩性心功能不全患者心功能状态的补充指标；血UA浓度还与血浆GSH浓度呈负相关、与血浆GSSG浓度及Eb值呈正相关，结合CSHF时UA的代谢途径，提示UA有可能作为氧化应激的指标。

Objective To study the relationship between the level of uric acid and oxidative stress in patients with chronic systolic heart failure （CSHF）. Methods One hundred and nine hospitalized patients from June 2006 to March 2007 were selected. Based on organic heart disease and heart function, they were classified into two groups： CSHF group （81 cases） and control group （28 cases）. According to NYHA heart function grade （ Ⅱ, Ⅲ, Ⅳ ）, CSHF group was divided into three subgroups. The plasma concentration of GSH and GSSG was determined by using glutathione reductase recycling method （GR-DTNB）. Redox potential （Eh） was calculated using Nemst equation according to the concentration of reduced and oxidized glutathione. Results There was significant difference between control group and CSHF group in the level of uric acid [ （310.54 ±99.92） umol/L vs （499.09 ± 168.04）umol/L], P 〈 0.01. Uric acid had a negative correlation with LVEF （r = -0.247 ,P = 0.026）, and a positive correlation with LVEDD （r = 0.266,P = 0.016）. The concentration of uric acid had a negative correlation with GSH （r = -0.328 ,P = 0.003 ）, and a positive correlation with GSSG （r = 0.244,P= 0.028） and Eh （r = 0.309,P= 0.005）. Conclusions The concentration of uric acid increases in CSHF patients and has a correlation with LVEF and LVEDD. It may be a supplementary marker to reflect heart function and the serious degree of CSHF. The concentration of uric acid has a negative correlation with GSH, and a positive correlation with GSSG and the value of Eh. It may be used as an indicator of oxidative stress concem＇ing its metabolic pathway.