老年慢性心力衰竭患者血清脂联素水平与左室射血分数及左室重构关系

Relationship between different serum levels of adiponectin and left ventricular ejection fraction or left ventricular remodeling in elderly patients with chronic heart failure

目的 探讨老年慢性心力衰竭（CHF）患者不同血清脂联素（APN）水平与左室射血分数（LVEF）和左室重构的关系。方法 选取自2012年4月~2014年4月间于重庆市渝北区人民医院心血管内科住院的老年慢性心力衰竭（心衰）患者133例,其中男性65例,女性66例,平均年龄（65.71±10.60）岁。根据纽约心脏病学会（NYHA）心功能分级标准分组：心功能I级组36例、心功能Ⅱ级组32例、心功能Ⅲ级组33例、心功能Ⅳ级组32例。同时根据血清APN水平,分为APN≥14 mg/L组（53例）和APN〈14mg/L组（80例）。应用超声心动图测定LVEF、左室舒张末期内径（LVEDd）、室间隔厚度（IVST）、左室后壁厚度（LVPWT）,计算左室质量（LVM）和左室质量指数（LVMI）。测定APN水平。结果 心衰各组较对照组血清APN水平明显增加,检测的超声指标LVEDd、IVST、LVPMT、LVM和LVMI也增加,差异有统计学意义（P均〈0.05）。APN≥14mg/L组的LVM、LVMI、LVEDd均显著高于APN〈14mg/L组,差异有统计学意义（P均〈0.05）。CHF患者血清APN与心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级组的LVEF呈明显负相关,r值分别为-0.198、-0.211、-0.363、-0.404（P均〈0.05）;血清APN与LVM、LVMI、LVEDd呈明显正相关,r值分别为0.421、0.391、0.398（P均〈0.05）。结论 老年CHF患者血清APN水平越高,LVEF越低,左室重构越严重。

Objective To investigate the relationship between different serum levels of adiponectin （APN） and left ventricular ejection fraction （LVEF） or left ventricular remodeling in elderly patients with chronic heart failure （CHF）. Methods The elderly patients with CHF （n=133, male 65, female 66 and average age=65.71±10.60） were chosen from Apr. 2012 to Apr. 2014. All patients were divided, according to NYHA standard, into grade I group （n=36）, grade II group （n=32）, grade III group （n=33） and grade IV group （n=32）, and at the same time, according to APN level, into APN≥14mg/L group （n=53） and APN〈14mg/L group （n=80）. The changes of left ventricular ejection fraction （LVEF）, left ventricular end-diastolic inner diameter （LVEDd）, interventricular septal thickness （IVST） and left ventricular posterior wall thickness （LVPWT） were detected by using echocardiogram, left ventricular mass （LVM） and left ventricular mass index （LVMI） were calculated, and APN level was detected. Results The serum level of APN increased significantly, and LVEDd, IVST, LVPMT, LVM and LVMI increased in grade I group, grade II group, grade III group and grade IV group compared with control group （all P〈0.05）. LVM, LVMI and LVEDd were significantly higher in APN≥14mg/L group than those in APN〈14mg/L group （all P〈0.05）. The serum level of APN was negatively correlated to LVEF significantly in grade I group, grade II group, grade III group and grade IV group （r=-0.198, r=-0.211, r=-0.363, r=-0.404, all P〈0.05）. The serum level of APN was positively correlated to LVM, LVMI and LVEDd significantly （r=0.421, r=0.391, r=0.398, all P〈0.05）. Conclusion The higher the APN level was, the lower LVEF was and the severer left ventricular remodeling was in elderly patients with CHF.