慢性心力衰竭患者血清同型半胱氨酸、尿酸和血脂水平的变化及意义

Change and significance of serum levels of homocysteine,uric acid and blood lipid in patients with chronic heart failure

目的观察慢性心力衰竭患者血清同型半胱氨酸(Hcy)、尿酸(UA)及总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白a[Lp(a)]等血脂相关指标水平的变化,分析上述指标与患者心功能的关系,探讨检测上述指标在慢性心力衰竭临床诊治中的应用价值。方法选取收治的慢性心力衰竭患者192例作为观察组,根据美国心脏病协会(NYHA)心功能分级分为Ⅱ级(n=46)、Ⅲ级(n=108)、Ⅳ级(n=38)3个亚组,另选取同期进行健康体检的体检人员74例作为对照组。比较观察组与对照组及3个亚组间血清Hcy、UA、TC、TG、HDL-C、LDL-C、Lp(a)水平,采用Spearman等级相关分析观察组患者血清Hcy、UA、TC、TG、HDL-C、LDL-C、Lp(a)水平与NYHA分级的关系。结果与对照组比较,观察组患者血清Hcy、UA、Lp(a)水平升高,TC、TG、HDL-C水平降低,差异有统计学意义(P<0.05),而组间血清LDL-C水平比较,差异无统计学意义(P>0.05);观察组心功能Ⅱ级、Ⅲ级、Ⅳ级3个亚组患者血清Hcy、UA、TC、TG、HDL-C、Lp(a)比较,差异有统计学意义(P<0.05),而组间血清LDL-C水平比较,差异无统计学意义(P>0.05);Spearman等级相关分析显示,观察组患者血清Hcy、UA、Lp(a)与NYHA分级呈正相关(P<0.05),TC、TG、HDL-C与NYHA分级呈负相关(P<0.05),LDL-C与NYHA分级无显著相关(P>0.05)。结论血清Hcy、UA、TC、TG、HDL-C、Lp(a)水平均随着慢性心力衰竭患者心功能的恶化而变化,可作为患者病情评估的参考指标,血清水平检测对指导早期干预治疗以降低远期心血管事件风险具有重要的意义。

Objective To observe the changes of serum levels of homocysteine（ Hcy）,uric acid（ UA）,total cholesterol（ TC）,triglyceride（ TG）,high density lipoprotein cholesterol（ HDL-C）,low density lipoprotein cholesterol（ LDL-C）,lipoprotein a [Lp（ a） ]in patients with chronic heart failure,and to analyze the correlation between these indexes and cardiac function in order to evaluate the clinical significance of these indexes in diagnosis and treatment of chronic heart failure. Methods One hundred and ninety-two patients with chronic heart failure who were admitted and treated in our hospital from February 2013 to August 2016 were selected as observation group,moreover,these patients were divided into three subgroup according to the cardiac function classification by American Heart Association（ NYHA）,grade Ⅱ subgroup（ n = 46）,grade Ⅲ subgroup（ n = 108） and grade IV subgroup（ n = 38）,furthermore,the other 74 healthy subjects were served as control group. The serum levels of Hcy,UA,TC,TG,HDL-C,LDL-C,Lp（ a） were detected and compared between observation group,control group and subgroups. The correlation between serum levels of Hcy,UA,TC,TG,HDL-C,LDL-C,Lp（ a） and cardiac function classification was analyzed by Spearman rank correlation analysis. Results As compared with those in control group,the serum levels of Hcy,UA,Lp（ a） in observation group were significantly increased,however,the serum levels of TC,TG,HDL-C were significantly decreased（ P〈 0. 05）,but there were no significant differences in serum levels of LDL-C between the two groups（ P〉 0. 05）. There were significantly differences in serum levels of Hcy,UA,TC,TG,HDL-C,Lp（ a） among grade Ⅱ group,grade Ⅲ group and Ⅳ subgroup（ P〈 0. 05）,but there were no significant differences in serum levels of LDL-C between any two subgroups（ P 〉0. 05）. Spearman rank correlation analysis showed that serum levels of Hcy,UA,Lp（ a） were positively correlated with NYHA classification（ P 〈0. 05）,however,the serum levels of TC,TG,HDL-C were negatively correlated with NYHA classification（ P〈 0. 05）,moreover,there was no significant correlation between the serum levels of LDL-C and NYHA classification（ P〉 0. 05）. Conclusion The serum levels of Hcy,UA,TC,TG,HDL-C and Lp（ a） are changed with the deterioration of cardiac function in patients with chronic heart failure,which may be used as reference indexes for assessment of patient＇s condition of disease,moreover,the detection of serum levels of these indexes has important clinical significance in instructing early intervention to reduce the risk of long-term cardiovascular events.