冠心病患者中无心功能不全与合并心功能不全的脂联素水平观察

Clinical detection of serum adiponectin between patients with coronary heart disease accompanied with congestive heart failure and patients with coronary heart disease accompanied without congestive heart failure

目的血清脂联素(adiponectin,APN),一种脂肪组织来源的胶原样血浆蛋白,具有抗动脉粥样硬化、抗炎及改善胰岛素敏感性等作用,本文旨在探讨冠心病无合并心功能不全组与冠心病合并心功能不全组血清脂联素水平及其与NTproBNP的关系,及探讨脂联素在冠心病合并慢性心功能不全发病机制中的作用。方法收集连续入院的冠心病合并NYHAII-IV级患者60例和冠心病无心功能不全患者60例的血清和临床资料,选取性别与年龄与病例组相匹配对照组25例,测定空腹血清脂联素水平、N末端前脑钠肽(N-terminal portion of proBNP,NTproBNP)、hsCRP(high sensitivity C-Reactive Protein)及生化指标,比较各组间脂联素水平及与NTproBNP、hsCRP及生化指标的关系。结果冠心病患者中无心功能不全组血清脂联素显著低于对照组,而冠心病合并心功能不全组显著高于冠心病无心功能不全组及对照组,且冠心病合并心功能不全组随着心功能不全分级的增加,脂联素水平是升高的。Spearson偏相关分析显示经年龄、性别及BMI校正后冠心病组脂联素水平与NT-proBNP、hs-CRP呈正相关,与LVEF、TC、TG呈负相关,多元逐步回归分析显示NTproBNP、HDL-C、TC是影响血浆APN的独立因素。结论本文研究发现冠心病无心功能不全患者血清脂联素水平明显低于对照组,而在冠心病合并心功能不全组血清脂联素是明显高于其他二组,且随着心功能不全分级的增加而明显递增,同时冠心病患者血清脂联素与NTproBNP及hsCRP呈正相关,提示脂联素可能参与冠心病及心功能不全的发病机制,其确凿的作用机制还有待进一步的深入研究证明,血清脂联素的变化趋势对于心功能不全的进展及转归可能有一定的指导意义。

Aim Adiponectin,which is a collagen-like plasma protein produced by adipose tissue, has anti-atherogenic and anti-inflammatory effects and improves insulin sensitivity. Our study aims to observe the serum levels of patients with coronary heart disease（CHD） accompanied with congestive heart failure（CHF） and patients with CHD accompanied without CHF, to investigate relationships between the serum levels of adiponectin and NTproBNP and the role of serum adiponectin in patients with CHD accompanied with CHF. Methods The study group comprised 120 patients with CHF who were consective in hospital and was divided into 2 subgroups. 25 control subjects came from health examination whose age and gender were similar to those in the study group. Serum levels of fasting adiponectin, NTproBNP,hsCRP and other biochemical indicators were measured and compared among the groups. Results serum adiponectin in no CHF group is lower than that in the control group ,but serum adiponectiu in CHF group is higher than that in the control group and serum adiponectin levels were significantly increased according to the severity of NYHA class in CHF group. In partial correlation analyses adjusted for gender, age and body mass index, adiponectin was postively associated with NT-proBNP and hsCRP, yet negatively associated with LVEF, TC and TG. Multiple linear regression showed that HDL-cholesterol （HDL-C）, TG and TC were independently correlated with the concentration of adiponectin level in patients with CHD. Conclusion Serum adiponectin levels in no CHF group significantly decreased in contrast with those in the control group, but serum adiponectin levels in CHF group increased higher than those in the other two groups, and according to the severity of CHF the level adiponectin were increased. Moreover, the level of adiponectin were positively correlated with the serum levels of NTproBNP and hsCRP. These results indicate that augmented release of adiponectin is involved in the pathogenesis of CHD and CHF. Further study is needed to elucidate its exact role. The change of the serum adiponectin is possibly valuable for evaluating the heart function and the prognosis of CHF.