血清H-FABP、Hcy水平与CHF患者心室重构及预后的关系

The relationship among serum H-FABP,Hcy levels and ventricular remodeling,prognosis in patients with CHF

目的:分析血清心型脂肪酸结合蛋白(H-FABP)、同型半胱氨酸(Hcy)水平与慢性心力衰竭(CHF)患者心室重构及预后的关系。方法:选择2013年5月至2015年11月我院收治的128例CHF患者为研究对象,根据纽约心脏病学会(NYHA)心功能分级患者被分为三组:心功能Ⅱ级48例、Ⅲ级42例及Ⅳ级38例,另选取同期入院治疗的心功能I级患者35例作为对照。超声心动图检查仪进行心脏检查,获取左室重构相关参数;入院次日采血检测血清H-FABP、Hcy水平;并进行相关性分析。所有患者均给予针对性强心治疗,随访24个月,以发生心脏事件为观察终点,记为预后不良,分析血清H-FABP、Hcy水平与预后的关系。结果:心功能I级、Ⅱ级、Ⅲ级、Ⅳ级患者左心室舒张末期内径(LVEDd)[(40.40±4.41)mm比(42.64±3.22)mm比(45.20±3.41)mm比(46.94±4.22)mm]、左心室后壁厚度(LVPWT)[(8.45±1.15)mm比(9.04±1.21)mm比(10.05±1.35)mm比(11.94±1.27)mm]、室间隔厚度(IVST)[(7.01±0.92)mm比(8.93±1.12)mm比(10.09±1.29)mm比(11.93±1.32)mm]均依次显著增大,左室射血分数(LVEF)[(52.16±4.02)%比(50.32±3.29)%比(48.16±3.32)%比(45.32±2.29)%]依次显著降低( P <0.05或 P <0.01),血清H-FABP[(3.36±0.71)ng/L比(4.13±1.13)ng/L比(5.65±1.42)ng/L比(6.49±1.69)ng/L]及Hcy[(9.46±1.55)μmol/L比(14.49±2.60)μmol/L比(17.71±3.61)μmol/L比(20.26±3.37)μmol/L]水平依次显著升高( P <0.05或<0.01)。经Pearson相关分析,血清H-FABP、Hcy水平与LVEDd、IVST、LVPWT呈显著正相关( r =0.312~0.392, P <0.05),与LVEF显著负相关( r =-0.453,-0.484, P <0.05或<0.01)。随访24个月,56例(43.75%)CHF患者预后不良,而与预后良好组比较,预后不良组的血清H-FABPP[(4.74±1.43)ng/L比(6.27±1.28)ng/L]及Hcy水平[(11.35±2.03)μmol/L比(18.33±3.46)μmol/L]均显著升高( P 均=0.001)。结论:血清H-FABP、Hcy水平与CHF患者心室重构发生过程存在一定相关性,且对病情及预后评估有重要作用。

Objective: To analyze the relationship among serum heart type fatty acid binding protein (HFABP),homocysteine (Hcy) levels and ventricular remodeling,prognosis in patients with chronic heart fail (CHF). Methods: A total of 128 patients with CHF admitted to our hospital from May 2013 to Nov 2015 were enrolled. According to the New York Heart Association (NYHA) cardiac function grading,patients were divided into three groups:grade II(n=48),grade III(n=42) and grade IV(n=38),at the sane time 35 patients with heart function grade I as a control group. Cardiac examination was performed by echocardiography to obtain parameters related to left ventricular remodeling. The levels fo serum H-FABP and Hcy were measured on the next day of admission,and correlation analysis was performed. All patients were treated with targeted cardiac therapy and followed up for 24 months. The cardiac events were used as the end point of the study,indicating poor prognosis. The relationship among serum H-FABP and Hcy levels and prognosis was analyzed. Results: Left ventricular end diastolic diameter (LVEDd)[(40.40±4.41)mm vs.(42.64±3.22)mm vs.(45.20±3.41)mm vs.(46.94±4.22)mm],left ventricular posterior wall thickness (LVPW)[(8.45±1.15)mm vs.(9.04±1.21)mm vs.(10.05±1.35)mm vs.(11.94±1.27)mm],and interventricular septum thickness (IVS)[(7.01±0.92)mm vs.(8.93±1.12)mm vs.(10.09±1.29)mm vs.(11.93±1.32) mm] were significantly increased in patients with grade I,II,III,and IV,and left ventricular ejection fraction ( LVEF)[(52.16±4.02)% vs.(50.32±3.29)% vs.(48.16±3.32)% vs.(45.32±2.29)%] decreased significantly ( P <0.05 or P <0.01),and serum H-FABP[(3.36±0.71)ng/L vs.(4.13±1.13) ng/L vs.(5.65±1.42)ng/L vs.(6.49±1.69)ng/L] and Hcy [(9.46±1.55)μmol/L vs.(14.49±2.60)μmol/L vs.(17.71±3.61)μmol/L vs.(20.26±3.37)μmol/L]levels increased significantly ( P <0.05 or P <0.01).Pearson correlation analysis showed that serum H-FABP and Hcy levels were positively correlated with LVEDd,IVS and LVPW ( r =0.312~0.392, P <0.05),and negatively correlated with LVEF ( r =-0.453,-0.484, P <0.05).During 24 months of follow-up,56 patients (43.75%) with CHF had a poor prognosis,compared with the prognosis group,serum H-FABPP [(4.74±1.43) ng/L vs.(6.27±1.28) ng/L] and Hcy level [(11.35±2.03)μmol/L vs.(18.33±3.46)μmol/L] in the poor prognosis group were significantly increased ( P =0.001 ). Conclusion: There is certain correlation between serum H-FABP and Hcy levels and ventricular remodeling in patients with CHF,which plays an important role in the assessment of disease and prognosis.