同型半胱氨酸在扩张型心肌病心力衰竭左室重构和心肌损伤中的临床意义

Clinical significance of homocysteine in dilated cardiomyopathy heart failure with left ventricular remodeling and myocardial damage

目的探讨同型半胱氨酸(HCY)在扩张型心肌病心力衰竭左室重构和心肌损伤中的临床意义。方法选取2008年3月至2012年6月扩张型心肌病(DCM)心衰患者89例,按照HCY水平分为HCY正常组43例和HCY升高组46例,观察血清HCY水平与左室射血分数、左室舒张末期容积、左室短轴缩短率和左室后壁厚度以及心肌酶学、血清肌钙蛋白的关系。结果与HCY正常组比较HCY升高组的LVEDV显著升高(P<0.01),LVEF、LVFS和LVPW显著降低(P<0.05),HCY升高组的CK-MB、AST和LDH水平显著升高(P<0.05),cTnT和cTnI水平显著升高(P<0.01),以上两组间的差异均有统计学意义。结论血清HCY可作为DCM心力衰竭左室重构和心肌损伤严重程度的有效评价指标。

Objective To study the clinical significance of homocysteine （HCY） in dilated cardiomyopathy heart failure with left ventricular remodeling and myocardial damage. Methods Eighty-nine patients with dilated car- diomyopathy （DCM） heart failure from March 2008 to June 2012 were divided into normal HCY group （n=43） and increased HCY group （n=46） according to serum HCY levels. The relationship between serum homocysteine levels and left ventricular ejection fraction （LVEF）, left ventricular end-diastolic volume （LVEDV）, left ventricular fraction- al shortening rate （LVFS） and left ventricular posterior wall thickness （LVPW）, serum cardiac enzymes, and serum troponin were observed. Results LVEDV was significantly higher in normal HCY group than increased HCY group （P〈0.01）. LVEF, LVFS and LVPW were significantly lower in normal HCY group than increased HCY group （P〈0.05）. CK-MB, AST and LDH were significantly higher in normal HCY group than increased HCY group （P〈0.05）, as well as cTnT and cTnI （P〈0.01）. Conclusion Serum HCY can be used as the effective evaluation of severity in patients of DCM heart failure with left ventricular remodeling and myocardial damage.