射血分数保留的心力衰竭患者褪黑素水平与心功能和血脂相关性研究

Correlation between serum melatonin level and cardiac function,blood lipid in patients of heart failure with preservation ejection fraction

目的探讨射血分数保留的心力衰竭(HFpEF)患者血清褪黑素水平与心功能和血脂的相关性.方法选取西安市第九医院2016年5月至2018年5月HFpEF患者170例(HFpEF组),其中纽约心脏病协会(NYHA)心功能分级Ⅱ级(心功能Ⅱ级)98例,Ⅲ级(心功能Ⅲ级)72例.另外,选择同期健康体检者32例作为对照组.两组均于2:00和7:00抽取静脉血,采用酶联免疫吸附法检测褪黑素水平.分析褪黑素水平与心功能和血脂的相关性(Pearson相关),指标包括三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、N末端前体脑利钠肽(NTproBNP)、超敏C反应蛋白(hs-CRP)、射血分数、左心室舒张末期容积指数(LVEDVI)、二尖瓣舒张早期与舒张晚期最大血流速度比值(E/A)和二尖瓣舒张早期血流速度峰值与二尖瓣环舒张早期运动速度峰值比值(E/e′).结果心功能Ⅲ级患者TG、TC、LDL-C、NTproBNP和hs-CRP明显高于心功能Ⅱ级患者[(1.51±0.69)mmol/L比(1.15±0.75)mmol/L、(4.03±1.02)mmol/L比(3.47±0.94)mmol/L、(1.42±0.33)mmol/L比(1.17±0.31)mmol/L、(3438.54±553.58)ng/L比(3034.58±557.35)ng/L和(4.26±2.54)mg/L比(3.12±2.13)mg/L],HDL-C、射血分数和E/A明显低于心功能Ⅱ级患者[(2.44±0.88)mmol/L比(2.97±0.94)mmol/L、(56.23±5.26)%比(61.11±5.33)%和0.82±0.18比0.91±0.17],差异有统计学意义(P<0.01).对照组和HFpEF组心功能Ⅱ级患者2:00和7:00褪黑素水平均明显高于HFpEF组心功能Ⅲ级患者[(454.24±123.54)和(432.68±155.68)ng/L比(368.85±98.52)ng/L、(483.25±90.54)和(418.54±103.57)ng/L比(345.85±98.52)ng/L],对照组7:00褪黑素水平明显高于HFpEF组心功能Ⅱ级患者,差异有统计学意义(P<0.01).HFpEF组心功能Ⅱ级患者褪黑素水平与TG、TC、LDL-C和HDL-C有相关性(P<0.01);HFpEF组心功能Ⅲ级患者褪黑素水平与NTproBNP、hs-CRP、射血分数、LVEDVI、E/A、E/e′、TG、TC、LDL-C和HDL-C均有相关性(P<0.01或<0.05).结论HFpEF患者的褪黑素水平与血脂有相关性.心功能Ⅲ级HFpEF患者褪黑素水平与心功能有相关性,但是在心功能Ⅱ级HFpEF患者中并未发现有相关性.

Objective To investigate the correlation between serum melatonin level and cardiac function,blood lipid in patients of heart failure with preserved ejection fraction(HFpEF).Methods One hundred and seventy patients with HFpEF(HFpEF group)in Ninth Hospital of Xi′an City from May 2016 to May 2018 were selected.According to the cardiac function grading of New York Heart Association(NYHA),Ⅱgrade(cardiac functionⅡgrade)was in 98 cases,andⅢgrade(cardiac functionⅢgrade)was in 72 cases.Then,32 healthy volunteers were selected as control group.The 2 groups were sampled at 2:00 and 7:00,and the level of melatonin was detected by enzyme-linked immunosorbent assay.The correlation between serum melatonin level and cardiac function,blood lipid were analyzed(Pearson correlation),including triglyeride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein-cholesterol(HDL-C),N-terminal precursor brain natriuretic peptide(NTproBNP),hypersensitive C reactive protein(hs-CRP),ejection fraction,left ventricular end-diastolic volume index(LVEDVI),miral diastolic early and end-diastolic maximum blood flow velocity ratio(E/A)and peak value of early diastolic blood flow velocity in the mitral valve and peak value of the early diastolic velocity of the mitral annulus(E/e′).Results The TG,TC,LDL-C,NTproBNP and hs-CRP in cardiac functionⅢgrade patients were significantly higher than those in cardiac functionⅡgrade patients:(1.51±0.69)mmol/L vs.(1.15±0.75)mmol/L,(4.03±1.02)mmol/L vs.(3.47±0.94)mmol/L,(1.42±0.33)mmol/L vs.(1.17±0.31)mmol/L,(3438.54±553.58)ng/L vs.(3034.58±557.35)ng/L and(4.26±2.54)mg/L vs.(3.12±2.13)mg/L,the HDL-C,ejection fraction and E/A were significantly lower than those in cardiac functionⅡgrade patients:(2.44±0.88)mmol/L vs.(2.97±0.94)mmol/L,(56.23±5.26)%vs.(61.11±5.33)%and 0.82±0.18 vs.0.91±0.17,and there were statistical differences(P<0.01).The melatonin levels at 2:00 and 7:00 in control group and cardiac functionⅡgrade patients of HFpEF group were significantly higher than those in cardiac functionⅢgrade patients of HFpEF group:(454.24±123.54)and(432.68±155.68)ng/L vs.(368.85±98.52)ng/L,(483.25±90.54)and(418.54±103.57)ng/L vs.(345.85±98.52)ng/L,the melatonin level at 7:00 in control group was significantly higher than that in cardiac functionⅡgrade patients of HFpEF group,and there was statistical difference(P<0.01).In cardiac functionⅡgrade patients of HFpEF group,the melatonin level was correlated with TG,TC,LDL-C and HDL-C(P<0.01);In cardiac functionⅢgrade patients of HFpEF group,the melatonin level was correlated with NTproBNP,hs-CRP,ejection fraction,LVEDVI,E/A,E/e′,TG,TC,LDL-C and HDL-C(P<0.01 or<0.05).Conclusions The melatonin level is correlated with the level of blood lipid in HFpEF patients.Melatonin level is correlated with cardiac functionⅢgrade patients,but this phenomenon is not observed in cardiac functionⅡgrade patients.