同型半胱氨酸与N-末端脑钠肽前体在慢性心力衰竭中的相关性分析

Correlative analysis between homocysteine and N-terminal pro-brain natriuretic peptide in chronic heart failure

目的通过观察同型半胱氨酸(Hcy)、N-末端脑钠肽前体(NT-proBNP)在慢性心力衰竭(CHF)患者血浆浓度的变化,探讨CHF患者血浆Hcy与NT-proBNP的相关性及临床应用价值。方法选择122例CHF住院患者,按照纽约心脏病协会(NYHA)心功能分级分为3组(NYHAⅡ级组,NYHAⅢ级组,NYHAⅣ级组),选择同期30例门诊健康体检者作为对照组。抽取清晨空腹血测定Hcy、NT-proBNP及生化全项(包括血糖、血脂、肾功能),CHF患者住院期间行心脏彩色超声(UCG)检查,测量左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)。观察CHF患者Hcy、NT-proBNP与心功能分级的关系,及Hcy与NT-proBNP的相关性。结果 122例CHF患者,高同型半胱氨酸血症73例(59.84%),明显高于健康对照组,两组比较差异有统计学意义(P<0.05)。随CHF患者NYHA分级的增加,Hcy、NT-proBNP、LVEDD逐渐增高(P<0.05)。CHF患者Hcy与NT-proBNP的增加呈正相关(r=0.445,P<0.05)。logistic回归分析显示,高Hcy是CHF的独立危险因素。结论 Hcy、NT-proBNP与心功能分级呈正相关,Hcy与NT-proBNP具有相关性,高Hcy是CHF的独立危险因素,二者结合可作为评价心功能状况的有效指标。

Objective To investigate the change of homocysteine（Hcy）and N-terminal pro-brain natriuretic peptide（NT proBNP）in patients with chronic heart failure（CHF）.Methods The study enrolled 122 patients with CHF who were divided into three groups according to NYHA function,NYHA Ⅱ,NYHA Ⅲ,NYHA Ⅳ.At the same time,30 healthy outpatients were selected as control group.The serum Hcy,NT proBNP and other biochemical indexes such as including blood glucose,lipids,renal function were detected.The left ventricular end diastolic diameter（LVEDD）and left ventricular ejection fraction（LVEF） were examined using ultrasound cardiogram during hospitalization.The relationship between Hcy and heart function classification was observed.Furthermore,the correlation between Hcy and NT proBNP was also observed.Results In 122 patients with CHF,hyperhomocysteinemia accounting for 59.84%（73cases）,was significantly higher than thatof control group（P〈0.05）.With higher cardiac function NYHA classification,Hcy,NT proBNP and LVEDD significantly increased（P〈0.05）.In CHF group,Hcy positively correlated with NT proBNP（r = 0.445,P〈0.05）.Logistic regression analysis indcated that hyperhomocysteinemia is an independent risk for CHF.Conclusion Hcy and NT proBNP were positively correlated to cardiac function classification.Meanwhile,there is correlation between Hcy and NT proBNP.Hyperhomocysteinemia is an independent risk for CHF.The combined application of Hcy and NT proBNP could be effective indexes for evaluating cardiac function.