慢性心力衰竭患者血清TBA水平与心室重构及炎症反应的相关性

Correlation between serum TBA level and ventricular remodeling and inflammatory response in patients with chronic heart failure

目的探讨慢性心力衰竭(心衰)患者血清总胆汁酸(TBA)水平与心室重构及炎症反应的相关性。方法收集2016年8月～2018年2月于首都医科大学附属北京安贞医院收治的123例慢性心衰患者为病例组,根据NYHA心功能分级标准将其分为NYHAⅡ级组(n=47)、NYHAⅢ级组(n=41)、NYHAⅣ级组(n=35),并于同期随机选取40例健康体检者为对照组(n=40)。采用酶循环法测定各组血清TBA水平;超声心动图检查心室重构参数包括左心室后壁厚度(LVPWT)、左心室后壁舒张末期厚度(PWD)、左心室后壁收缩末期厚度(PWS)、室间隔收缩末期厚度(IVSS)及左室心肌质量指数(LVMI);放射免疫法测定血清炎症因子包括白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及超敏C反应蛋白(hsCRP)水平。采用Pearson积矩相关分析研究TBA与心室重构参数及炎症因子指标的关系。结果病例组血清TBA水平高于对照组,且随着患者NYHA分级越高,血清TBA水平越高,差异有统计学意义(P<0.05);病例组心室重构参数LVPWT、PWD、PWS、IVSS、LVMI大于对照组,且随着患者NYHA分级越高,心室重构参数越大,差异有统计学意义(P<0.05);病例组血清IL-6、TNF-α、hs-CRP水平高于对照组,且随着患者NYHA分级增加,血清IL-6、TNF-α、hs-CRP水平越高,差异有统计学意义(P<0.05)。Pearson积矩相关分析表明,慢性心衰患者血清TBA水平与心室重构参数LVPWT、PWD、PWS、IVSS、LVMI呈正相关性(r=0.243～0.392,P<0.05),也与炎症细胞因子IL-6、TNF-α、hs-CRP水平呈正相关性(r=0.394～0.427,P<0.05)。结论慢性心衰患者血清TBA异常升高,且与心室重构、炎症反应密切相关,早期检测TBA或可辅助临床评估慢性心衰患者的病情严重程度。

Objective To investigate the correlation between serum total bile acid(TBA)levels and ventricular remodeling and inflammatory response in patients with chronic heart failure.Methods A total of 123 patients with chronic heart failure admitted to Beijing Anzhen Hospital from August 2016 to February 2018 as case group were enrolled to this study,who were divided into NYHA class II group(n=47),NYHA classⅢgroup(n=41)and NYHA classⅣ(n=35)according to the NYHA functional class criteria.At the same time,40 healthy volunteers were randomly selected as the control group.Serum TBA levels were determined by enzyme circulation method;echocardiographic examination of ventricular remodeling parameters including left ventricular posterior wall thickness(LVPWT),left ventricular posterior wall end-diastolic thickness(PWD),left ventricular posterior wall end-systolic thickness(PWS),ventricular septal end-systolic thickness(IVSS)and left ventricular myocardial mass index(LVMI);radioimmunoassay for serum inflammatory factors including interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and super Sensitive C-reactive protein(hs-CRP)levels.The relationship between TBA and ventricular remodeling parameters and inflammatory factors were analyzed by Pearson moment correlation analysis.Results The serum TBA level in case group was higher than that in control group.With the higher the NYHA classification,patients have the higher TBA level,and the difference was statistically significant(P<0.05).The ventricular remodeling parameters such as LVPWT,PWD,PWS,IVSS,LVMI in case group were higher than those in control group,and the higher the NYHA classification in patients,the higher these indexes,and the difference was statistically significant(P<0.05).The serum IL-6,TNF-α,hs-CRP in case group were higher than those in control group,and the higher the NYHA classification in patients,the higher these parameters,and the difference was statistically significant(P<0.05).Pearson product moment correlation analysis showed that the level of serum TBA in patients with chronic heart failure was positively associated with ventricular remodeling parameters LVPWT,PWD,PWS,IVSS,LVMI(r=0.243~0.392,P<0.05)and also positively associated with the level of IL-6,TNF-α,hs-CRP(r=0.394~0.427,P<0.05).Conclusion The level of serum TBA in patients with chronic heart failure is abnormally elevated,which is closely related to ventricular remodeling and inflammatory response.The early detection of TBA is significant for the clinical evaluation of chronic heart failure.