194例慢性心力衰竭患者血脂水平的临床分析

Clinical analysis of blood lipid levels in 194 patients with chronic heart failure

目的了解慢性心力衰竭(CHF)患者的血脂水平,为临床治疗提供参考。方法回顾性调查华山医院在2003年1月1日至2005年12月31日间出院诊断为CHF(心功能NYHA分级Ⅱ-Ⅳ级)194例患者的病史资料,为CHF组,同期收集出院诊断为冠心病和/或高血压病,心功能正常、临床特征匹配的150例患者为对照组,分析患者血脂水平。统计采用P检验及卡方检验。结果与对照组相比,CHF组血清总胆固醇(TC)水平(4.43和4.81mmol/L,P<0.05),及高密度脂蛋白(HDL-C)水平较低(1.16和1.87mmol/L,P<0.05),低密度脂蛋白(LDL-C)高(2.62和2.07mmol/L,P<0.05)。按NYHA级别分组,各组间血脂水平无明显差异,但随心功能NYHA分级的提高,他汀药物服用率有降低趋势(对照组、NYHAⅡ级组、NYHAⅢ级组、NYHAⅣ级组分别为58.7%、37.1%、32.6%、28.3%)。在按病因分组的亚组分析中,各组血脂水平无明显差异。结论 CHF患者与对照组相比血清总胆固醇及高密度脂蛋白水平低,低密度脂蛋白高,服用降脂药比例低。血脂水平在不同心功能分组及不同病因分组间无明显差异。

Objective To analyze the blood lipid levels in patients with chronic heart failure （CHF）, and to provide reference for treatment of CHF. Methods Retrospective survey was performed on the clinical data of 194 patients diagnosed with CHF at discharge （New York Heart Association （NYHA） functional classification II-IV ） who were hospitalized in Hua Shan Hospital of Fudan University between January 1, 2003 and December 31, 2005. In addition to the CHF patients （CHF group）, 150 patients who were diagnosed with coronary heart disease and/or hypertension at discharge, had normal cardiac function, and showed matched clinical manifestations were assigned to control group. P test and chi-square test were used in statistics. Results Compared with the control group, the CHF group showed lower serum total cholesterol （TC） level （4.42 mmol/L vs 4.75 mmol/L, P〈0.05）, lower serum high-density lipoprotein cholesterol （HDL-C） level （1.16 mmol/L vs 1.87 mmol/L, P〈0.05）, and higher serum low-density lipoprotein cholesterol （LDL-C） level （2.62 mmol/L vs 2.07 mmol/L, P〈0.05）. There were no significant differences in blood lipid levels among NYHA functional classification subgroups, but the taking rate of statin decreased as the NYHA grade increased （control group 59.8%, NYHA II subgroup 37.1%, NYHA 111 subgroup 32.6%, and NYHA IV subgroup 28.3% ）. No significant differences were found among the disease canse-based subgroups with respect to blood lipid levels. Conclusion CHF patients have lower serum TC and HDL-C levels, higher serum LDL-C level, and lower statin taking rate than those with coronary heart disease and/or hypertension and normal cardiac function. There are no significant differences in blood lipid levels among patients with different cardiac functions and different disease causes.