摘要
目的探讨老年冠心病慢性充血性心力衰竭（CHF）患者血清CA125水平与心功能等相关因素之间的关系。方法测定178例老年冠心病CHF患者血清肿瘤标志物CA125、癌胚抗原（CEA）、甲胎蛋白（AFP）、CA199、CA15—3、CA724以及肝肾功能和N末端脑钠肽（NT-proBNP）；超声心动图测定二尖瓣舒张早期E峰最大流速（Ve）、舒张晚期A峰最大流速（Va）、Ve／Va、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）及左心室射血分数（LVEF）、左心室射血时间。所有患者根据NYHA分为Ⅰ＋Ⅱ、Ⅲ、Ⅳ级3组；统计其胸腔积液、外周水肿、心房颤动的发生率。结果（1）178例患者中血清CA125≤35U／m191例，CA125中位数9．9（3．4～33．7）U／ml；〉35U／m187例，中位数64．4（20．2—462．1）U／ml。CA125〉35U／ml组NYHA心功能Ⅲ＋Ⅳ级82例，Ⅰ＋Ⅱ级5例；≤35U／ml组Ⅲ＋Ⅳ级7例，Ⅰ＋Ⅱ级84例，组间心功能差异有统计学意义（X^2=133．3，P〈0．001）。CA125增高组胸腔积液、心房颤动、外周水肿的发生率高于CA125≤35U／ml组[32．2％（28／87）、5．5％（5／91），51．7％（45／87）、9．9％（9／91），78．2％（68／87）、19．8％（18／91），P均〈0．01]，NT—proBNP、LVESD、LVEF、左心室射血时间比较差异均有统计学意义[2524．0（104．0～19308．0）、356．0（32．0—5201．1）ng／L，35（27—55）、32（26—53）mm，49％（23％-66％）、59％（42％～69％），268（210～312）、290（260～340）ms，P均〈0．05]。（2）直线回归显示：血清CA125与血浆NT—proBNP、尿素氮呈正相关（r=0．3326、P=0．002，r=0．3430、P=0．002），与LVEF、左心室射血时间呈负相关（r=-0．3016、P=0．006，r=-0．3336、P=0．004）。结论老年冠心病CHF患者血清CA125随着心功能分级恶化而升高，并且与血浆NT-proBNP水平、LVEF、左心室射血时间以及有无胸腔积液、心房颤动、外周水肿等因素有关。
Objective To assess the association between serum levels of carbohydrate antigen 125 （CA125） and the heart function in the elderly with congestive heart failure （CHF）. Methods CA125, carcinoembryonic antigen （ CEA）, alpha-fetoprotein （ AFP）, CA199, CA15-3, CA724, liver and kidney function and NT-proBNP were measured in 178 patients with heart failure. Ve, Va, Ve/Va, left ventricular end-diastolic diamete （ LVEDD）, left ventricular end-systolic diamete （ LVESD ）, left ventricular ejection fraction （LVEF） and time were measured using echocardiograph. All patients were classified as Ⅰ ＋ Ⅱ. Ⅲ and Ⅳ level according to the criteria of New York Heart Assocation （ NYHA）, and the incidence of pleural effusion, peripheral edema, atrial fibrillation were observed. Results Among the 178 patients,serum CA125 were ≤35 U/ml in 91 patients with median of 9. 9 （3.4 - 33.7） U/ml, 〉 35 U/ml in 87 patients with median of 64.4 （ 20. 2 - 462. 1 ） U/ml. Among those patients with CA125 〉 35 U/ml ,heart function was classified as level Ⅲ ＋ Ⅳ in 82 patients,and level Ⅰ ＋ Ⅱ in 5 patients. Among the patients with CA125 ≤35 U/ml, heart function was classified as level Ⅲ ＋ Ⅳin 7 patients, and level Ⅰ ＋ Ⅱ in 84 patients. Heart function was significantly different between the two CA125 groups（ X^2 = 133.3 ,P 〈 0. 001 ）. The incidence of pleural effusion, atrial fibrillation, peripheral edema in the higher CA125 group were 32. 2% ,51.7% and 78.2% , respectively, which were significantly higher than those in the normal CA125 group （ 5.5% ,9.9% and 19.8%, repactively） （ P 〈 0. 01 ）. NT-proBNP, LVESD, LVEF and time in the higher CA125 group were 2524. 0（ 104. 0 - 19 308.0） ng/L,35 （ 27 - 55 ） mm ,49% （23% -66% ） and 268（210- 312）ms,which were significantly differenct from those in the normal CA125 group [ 356. 0 （ 32. 0 - 5201.0） ng/L, 32 （ 26 - 53 ） mm, 59% （ 42% - 69% ） and 290 （ 260 - 340 ） ms, respectively ] （Ps 〈0. 05）. The linear regression showed that serum CA125 was positively correlated with NT-ProBNP and urea nitrogen （ BUN ） （ r = 0. 3326 and 0. 3430, Ps = 0. 002 ） , as well as negtively correlated with LVEF and time （r = -0. 3016,P =0. 006;r = -0. 336,P =0. 004）. Conclusion Serum CA125 in the elderly with congestive heart failure increased with the worsing of heart function, and correlated with the level of NT-proBNP, LVEF and time, as well as pleural effusion, atrial fibrillation, peripheral edema.
出处
《中国综合临床》
2011年第3期252-255,共4页
Clinical Medicine of China
