慢性心力衰竭患者血清白蛋白浓度变化及临床意义

Changes of serum concentration of albumin in patients with chronic heart failure and its clinical significance

目的探讨血清白蛋白浓度在慢性心力衰竭(heart failure,HF)患者中的浓度及其与心功能、心室重构的关系。方法选入纽约心脏协会(New York Heart Association,NYHA)分级为Ⅱ~Ⅳ级HF患者127例为实验组。分别按照NYHA心功能分级及左心室射血分数(left ventricular ejection fraction,LVEF)分组:LVEF<50%为LVEF降低组,LVEF≥50%为LVEF保留组;选取年龄、性别比例与HF组匹配的健康人28名为对照组。分别测定血清白蛋白浓度、血浆氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度及检查超声心动图等,组间比较并进行相关性分析。结果实验组血清白蛋白浓度明显低于对照组,且随着NYHA心功能分级增高,其浓度也随之降低。与LVEF降低组比,LVEF保留组NT-proBNP浓度、左心室舒张末期内径(left ventricular end diastolic dimension,LVEDD)、左心室质量指数(left ventricular mass index,LVMI)较低,而白蛋白浓度较高,差异有统计学意义(均P<0.05)。白蛋白与NYHA心功能分级、NT-proBNP呈负相关(r=-0.53,-0.283;P<0.01),与LVEF呈正相关(r=0.211,P<0.05),与LVEDD、LVMI无明显相关性(P>0.05)。结论血清白蛋白浓度可用于评估HF患者的心功能状况及心力衰竭类型,但尚不能评估HF患者左心室重构的程度。

Objectives To investigate the expression of serum albumin(ALB)in patients with chronic heart failure(HF)and its relationship with cardiac function and ventricular remodeling.Method Totally127HF patients withNew York Heart Association(NYHA)classificationⅡ,Ⅲ,Ⅳgrade were enrolled in this study.They were groupedaccording to NYHA classification and left ventricular ejection fraction(LVEF):patients with LVEF≥50%were inLVEF retention group and patients with LVEF<50%were in non-LVEF retention group.At the same period,28healthy subjects were selected as control group.Serum concentration of ALB,plasma concentration of N-terminal pro-B-type natriuretic peptide(NT-proBNP)and echocardiography were measured and compared between the two groups.Correlation analysis was carried out among the indexes.Results Serum concentration of ALB in HF group was signifi?cantly lower than that in control group,and serum concentrations of ALB also decreased with the increase of NYHA car?diac function.Compared with non-LVEF retention group,LVEF retention group had lower serum concentration of NTproBNP,left ventricular end diastolic dimension(LVEDD),left ventricular mass index(LVMI)and higher serum con?centration of ALB(All P<0.05).Serum concentration of ALB negatively correlated with NYHA functional class andNT-proBNP(r=-0.53,-0.283;P<0.01);it positively correlated with LVEF(r=0.211,P<0.05).There was no signifi?cant correlation between LVEDD and LVMI.Conclusions Serum concentration of ALB can be used to evaluate heartfunction and type in patients with HF,but it can not assess the extent of left ventricular remodeling.