心力衰竭患者血尿酸与有创血液动力学监测指标、血浆N末端B型利钠肽原和高敏C反应蛋白的相关研究

Association of serum uric acid, plasma NT-proBNP, Hs-C reactive protein and invasive hemodynamic parameters in patients with heart failure

目的评价心力衰竭（心衰）患者血尿酸与有创血液动力学监测指标、血浆N末端B型利钠肽原（NT-proBNP）和高敏c反应蛋白（Hs-CRP）的相关性。方法选择141例NYHAⅡ-Ⅳ级心衰患者，在入院12h内行漂浮导管监测和血尿酸等常规检查，同时检测血浆NT-proBNP和Hs-CRP。结果高尿酸血症的比率为55.30％，肺毛细血管楔压（PCWP）在高尿酸血症总组及高尿酸血症A、B、C组均较正常血尿酸组显著增高（P〈0.01，P=0.01，P〈0.01，P〈0.01）。血浆NT-proBNP在高尿酸血症总组和高尿酸血症c组较正常血尿酸组显著增高（P=0.02，P〈0.01）。与PCWP〈18mmHg（1mm Hg=0.133kPa）组比较，高NT-proBNP和高尿酸血症比率在PCWP≥18mmHg、〈28mmHg组和PCWP／〉28mmHg组均显著增高（P=0.01，P=0.02；P〈0.01，P〈0.01）。偏相关分析表明，血尿酸分别与右房压、右室压、肺动脉压和PCWP相关（r=0.19，P=0.03；r=0.45，P〈0.01；r=0.23，P=0.01；r=0.24，P=0.01）。多元回归分析表明，血尿酸和血浆NT—proBNP分别与PCWP独立相关（B=0.24，P=0.01；13=0.47，P〈0.01）。血浆Hs-CRP以及左室射血分数与血尿酸及PCWP均不相关。结论心衰患者血尿酸水平与PCWP等有创血液动力学指标独立相关，与血浆NT.proBNP结合可能更有利于心衰患者的临床评价。

Objective To explore the correlation of serum uric acid, invasive hemodynamic parameters, plasma N-terminal proBNP （NT-proBNP） and Hs-C reactive protein （Hs-CRP）in patients with heart failure. Method Invasive hemodynamie parameters derived from Swan-Ganz catheter, serum uric acid, plasma NT-proBNP and Hs-CRP within 12 hours after hospital admission were analyzed in 141 patients with chronic heart failure [New York Heart Association （NYHA） classⅡ-Ⅳ]. Results Incidence of hyperuricemia was 55.30% in this patient cohort. Pulmonary capillary wedge pressure（PCWP） and plasma NT-proBNP in hyperuricemia patients were significantly higher than those in non-hyperuricemia patients （ P 〈 0. 01 ）. The percentages of high plasma NT-proBNP （ 〉 600 pmol/L） and hyperuricemia were significantly higher in patients with PCWP≥18 and 〈 28 mm Hg （1 mm Hg = 0.133 kPa） and patients with PCWP≥28mm Hg compared those in patients with PCWP 〈 18 mm Hg, （ P = 0. 01, P = 0. 02 ; P 〈 0. 01, P 〈 0. 01, respectively）. Partial correlation analysis showed that serum uric acid correlated with fight atrial pressure, fight ventricular pressure, pulmonary arterial pressure and PCWP （r = 0. 19,P = 0. 03 ; r = 0. 45,P 〈 0. 01 ; r = 0. 23, P = 0. 01 ; r = 0. 24, P = 0. 01, respectively）. Multiple linear regression analysis showed both serum uric acid and plasma NT-proBNP correlated independently with PCWP （ 13 = 0. 24, P = 0. 01 ; β= 0.47, P 〈 0. 01, respectively） while plasma Hs-CRP and left ventricular ejection fraction were not correlated with serum uric acid and PCWP （ P 〉 0. 05 ）. Conclusion Serum uric acid independently correlated with PCWP in patients with heart failure and the combined measurements of serum uric acid and plasma NT-proBNP are helpful in evaluating the prognosis of patients with heart failure.