老年心功能不全患者缺血修饰白蛋白水平及左心室射血分数的变化

The study of changes of plasma ischemia-modified albumin and left ventricular ejection fraction in old patients with cardiac dysfunction

目的研究老年患者不同心功能状态下缺血修饰白蛋白（IMA）水平，左心室射血分数（LVEF）及其两者之间的相关性。方法2010年4月至2011年6月入住我院急诊科病房及ICU的84例心功能不全患者，将84例患者按美国纽约心脏病学会（NYHA）分级分为3组Ⅱ、Ⅲ、Ⅳ级组，另按照病情转归将患者分为症状缓解组及病情加重／死亡组，记录患者病史、常规血生化监测、测定IMA及行心脏彩超检查。分析IMA与LVEF的相关性。结果心功能呶组的血清IMA[（45．24±11．31）U／ml]明显低于心功能Ⅲ级组[（60．43±10．73）U／ml]和Ⅳ级组[（86．42±12．25）U／ml]，差异有统计学意义（P〈0．05）；症状缓解组治疗后IMA降低[（70．12±12．41）U／ml比（48．94±10．34）U／m1]，该组治疗前后IMA、LVEF比较，差异有统计学意义（P〈0．05）；病情加重／死亡组治疗后IMA升高[（81．18±11．47）U／ml比（64．40±10．78）U／ml]，该组治疗前后IMA、LVEF比较，差异有统计学意义（P〈0．05）；缓解组与病情加重／死亡组治疗前血IMA、LVEF及治疗后血IMA、LVEF组间比较差异有统计学意义（P〈0．05）。IMA与LVEF呈负相关（r=-0．619，P〈0．01）。结论老年心功能不全患者血浆IMA浓度明显升高，并与NYHA心功能分级呈正相关，与LVEF呈负相关，经过治疗病情平稳后IMA水平回落。

Objective To observe the changes of plasma ischemia-modified albumin （IMA） and left ventricular ejection fraction （LVEF）in old patients with cardiac dysfunction, and to explore the association between the IMA and left ventricular function. Methods Eighty-four cardiac dysfunction patients admitted to emergency room and ICU of Xuanwu hospital from April 2010 to June 2011 were enrolled. Eighty-four cases of patients were divided into three groups according to NYHA classification. They are NYHA Ⅱ , Ⅲ,Ⅳ. We recorded the patient＇s general condition, measured blood biochemical and the plasma IMA after admission, before discharge or illness worsened. Echocardiography was also examined. We studied the association between IMA and left ventricular ejection fraction （LVEF） values. Results IMA level of cardiac function class Ⅱ （45.24 ± 11.31 ） U/ml was lower than that of class Ⅲ/（60.43 ± 10.73） U/ml and class IV （86.42 ± 12.25 ） U/ml （P 〈 0.05）. The blood IMA, LVEF had statistical difference before and after treatment in recovering group and illness worsen/death group （ P 〈 0.05 ）. Before treatment the blood IMA, LVEF between recovering group and death group had statistical significance and after treatment those also had statistical significance （ P 〈 0.05 ） between two groups. IMA has negative correlation with LVEF value（r = -0. 619,P 〈 O. 01 ）. Conclusions The IMA concentrations in the plasma of patients with cardiac dysfunction increases with the heart function levels and declined the ejection fraction of left ventricular. IMA level sig- nificantly increases when patients are stable.