肾上腺髓质素与神经肽Y在慢性心率增快心力衰竭患者中的变化及临床意义

The Changes and Clinical Significance of Adrenomedullin and Neuropeptide Y Levels in Chronic Heart Failure Patients with Elevated Heart Rate

目的 观察存在慢性心率增快的慢性心力衰竭患者血浆肾上腺髓质素（ADM）、神经肽Y（NPY）水平变化及临床意义,进一步探讨其在慢性心率增快中的作用。方法 将2011～2012年收住我院的慢性心力衰竭患者,根据患者入院时24 h动态心电图结果分为慢性心率增快组：80例,平均心率≥80次/分；非慢性心率增快组：80例,平均心率＜80次/分。使用酶联免疫吸附法测定两组慢性心力衰竭患者的血浆ADM、NPY、脑钠肽水平，用超声心动图测量左心房内径、左心室舒张末内径、左心室射血分数、左心室短轴缩短率。结果 慢性心率增快组慢性心力衰竭患者的血浆ADM、NPY水平均高于非慢性心率增快组（P〈0.05）,随NYHA分级逐级增高，差异有统计学意义（P〈0.01）。单因素分析显示ADM、NPY水平与左心房内径呈正相关（P〈0.001），与左心室射血分数、左心室短轴缩短率呈负相关（P〈0.001）。结论 ADM、NPY可能参与了慢性心力衰竭中慢性心率增快的病理生理过程，是心力衰竭恶化的危险因素。

Aim To explore the changes of adrenomedullin （ADM） and neuropeptide Y （NPY） levels and further analyze the clinical significance in chronic heart failure （CHF） patients with elevated heart rate. Methods According to the result of 24-hour dynamic electrocardiogram examination on admission CHF patients between 2011 and 2012,80 patients whose average heart rate was more than 80 bpm were divided into the elevated heart rate group and another 80 patients whose heart rate was low than 80 bmp as control group. Every subject’s plasma ADM, NPY and brain natriuretic peptide （BNP） were detected by enzyme-linked immunosorbent assay （ELISA）. The parameters of left atrial diameter （LAD）, left ventricle end-diameter （LVED）, left ventricle ejection fraction （LVEF）, fraction shortening （FS） were detected by echocardiography. Results The plasma ADM, NPY levels increased with the cardiac functional grading （P〈0.01） There is a significant difference between two groups compared by independent t-test. The elevated heart rate group had higher levels of plasma ADM and NPY than control group （P〈0.05）. The levels of ADM and NPY were positively correlated with LAD （P〈0.001）, and negatively correlated with LVEF and FS （P〈0.001）. Conclusion ADM and NPY may be involved in the pathophysiologic processes of CHF with elevated heart rate which are risk factors for developing heart failure.