高密度脂蛋白胆固醇水平与慢性心力衰竭严重程度的相关性

Correlationship between high density lipoprotein cholesterol levels and NYHA classification of chronic heart failure in patients

目的:探讨心力衰竭患者心功能严重程度(NYHA分级)与血清HDL-C水平的相关性。方法:回顾性收集2013年8月至2016年8月,北京安贞医院心内科收治的心力衰竭患者209例(心功能分级NYHA分级Ⅱ~Ⅳ级)为心力衰竭组,根据病因分为缺血性心肌病(ICM)组和扩张性心肌病(DCM)组;其他原因入院的心功能正常的非器质性心脏病患者104例为对照组。比较各组一般资料,血脂及血清脑钠肽(取对数值Lg BNP)是否存在差异;比较ICM组与DCM组NYHA分级III-IV级的严重心力衰竭患者HDL-C,LDL-C水平及心脏超声各指标的差异;相关分析心力衰竭NYHA分级与HDL-C的相关性。结果:心力衰竭组收缩压和BNP显著低于对照组(P<0.01);ICM组LDL-C水平高于DCM组和对照组(P<0.05),HDL-C水平低于DCM组和对照组(P<0.05)。NYHA分级III-IV级心力衰竭患者,DCM组LVEDD大于ICM组,室间隔厚度小于ICM组(P<0.01)。ICM组和DCM组心功能III-IV级心力衰竭患者HDL-C水平均低于心功能II级患者(P<0.05)。Spearman相关分析显示,HDL-C水平与心力衰竭患者NYHA分级均呈负相关(r=-0.290,P=0.01,r=-0.235,P<0.05)。结论:ICM和DCM心力衰竭患者HDL-C水平均有降低,ICM组HDL-C水平更低,且HDL-C水平与ICM和DCM的CHF患者的心力衰竭严重程度均呈负相关。

Objective： To analyze the correlation of serum HDL-C level and degree of chronic heart failure（ CHF） in patients. Methods： A total of 209 patients who were diagnosed with heart failure（ cardiac function NYHAⅡ - Ⅳ classification） by the Department of Cardiology of Beijing Anzhen Hospital,between July2013 to July 2016 were retrospectively enrolled as HF group and categorized into ischemic cardiomyopathy（ ICM） group and dilated cardiomyopathy（ DCM） group by etiology. 104 patients hospitalized for other reasons with non organic heart disease and normal cardiac function were selected as control group. Clinical general data,blood lipids level and the logarithm of serum brain natriuretic peptide（ Lg BNP） of each group were compared. The HDL-C levels,LDL-C levels and several indexes of echocardiography of ICM group with severe heart failure（ NYHA class Ⅲ - Ⅳ） were compared respectively with DCM group. Spearman correlation analysis was used to analyze correlation between NYHA classification and HDL-C level in patients with HF. Results：Systolic pressure and lg（ BNP） of the HF group was significantly lower than those of control group（ P〈0.01）The levels of LDL-C were lower and the levels of HDL-C were higher in patients of ICM group than those of the other two groups（ P〈0.05） Compared with people in the DCM group,the LVEDD were larger and the interventricular septal depth（ IVSD） were thinner in patients of ICM group of NYHA class Ⅲ - Ⅳ（ P〈0.01） The levels of HDL-C in HF patients of Ⅲ - Ⅳ classification were comparatively decreased than those of Ⅱclassification both in ICM group and DCM group（ P〈0.05） Spearman correlation analyses demonstrated that the levels of HDL-C negatively correlated with NYHA classification both in ICM group and DCM group（ r =-0. 290,P =0. 01）,（ r =-0. 235,P〈0.05） Conclusion： Both in patients of ICM and DCM with HF,the levels of HDL-C which were obviously decreased,were negatively related to NYHA classification of CHF.