心力衰竭患者尿酸水平与ACC/AHA心力衰竭分期的相关性研究

Correlation between uric acid level and ACC/AHA stages for heart failure

目的探讨血清尿酸(UA)水平与心力衰竭不同分期的相关性。方法入选2007年7月至2008年9月在北京大学第三医院心内科住院的患者116例,按照美国心脏病学会和美国心脏病协会(ACC/AHA)2005年的心力衰竭指南对患者进行分期:A期(心力衰竭高危期)为心力衰竭高危患者,但无结构性心脏病或心力衰竭症状;B期(心脏结构改变期)为结构性心脏病但无心力衰竭症状;C期(心功能衰竭期)为结构性心脏病但曾经或现有心力衰竭症状。测定血清UA,血浆N末端脑利钠肽(NT-proBNP)水平和超声心动指标。结果C期患者的血UA水平较B期和A期明显升高(434.7±145.1)μmol/L vs(304.5±60.8)μmol/L、(369.7±75.1)μmol/L(P<0.01或<0.05),而B期较A期有升高趋势,但差异无统计学意义(P=0.061)。NT-proBNP则随着ACC/AHA分期的进展相应增加,(37.7±158.4)ng/L、(537.6±201.0)ng/L和(2 574.0±2 541.0)ng/L,3组间Hc=35.185,P<0.01。血UA水平与NT-proBNP浓度(r=0.555,P<0.001),左心房直径(LA)(r=0.411,P=0.002)和右心室内径(RV)(r=0.496,P=0.000)显著相关。结论血清UA水平与美国ACC/AHA心力衰竭分期、NT-proBNP、LA和RV显著正相关,可能是心脏结构和功能改变的预测指标之一。

Objective To determine the relationship between the concentration of serum uric acid and ACC/ AHA stages for heart failure. Methods A total of 116 subjects were enrolled in the study. Patients were classified according to ACC/AHA 2005 guideline for the chronic heart failure patients. The patients at high risk of heart failure without structural heart disease or symptoms of heart failure were defined as high risk of heart failure （stage A）,the structural heart disease patients without signs or symptoms of heart failure as structure heart disease （stage B） and the structural heart disease patients with prior or current symptoms of heart failure as heart failure （stage C）. The levels of uric acid, N-terminal prohormone brain natriuretic peptide （NT-proBNP） and echocardiography indicators were measured. Results The serum concentrations of uric acid were much higher at stage C patients than stage A and stage B, （434.7±145.1） μmol/L vs （304.5±60.8） μmol/L, （369.7 ±75.1） μmol/L（ P 〈0.01 or 〈0.05）. There is a tendency of increase from stage B to stage A,which is however not significant（ P = 0.061）. The concentration of NT-proBNP elevated according to the stages of heart failure stage A（37. 7±158.4） ng/L,stage B（537.6±201.0） ng/L, stage C（2 574±2 541） ng/L（ P 〈0.01）. Partial correlation analysis showed that the level of uric acid was positive correlated with NT-proBNP（ r =0. 555, P 〈0.001）,the diameter of left atrium（ r =0. 411, P =0. 002） and right ventricle（ r =0. 496, P = 0. 000）. Conclusion Serum uric acid level is correlated with the stages of heart failure, NT-proBNP,the diameter of left atrium and right ventricle. Uric acid could be a helpful marker in indentifying the structural and functional change in heart failure patients.