老年慢性阻塞性肺疾病急性加重期并发慢性心衰患者血浆同型半胱氨酸水平的变化及意义

Changes and significance of plasma homocysteine levels in elderly patients with AECOPD complicated with chronic heart failure

目的探讨血浆同型半胱氨酸(Hcy)水平与老年慢性阻塞性肺疾病急性加重期(AECOPD)患者并发慢性心衰的关系。方法选取AECOPD患者300例,其中慢性心衰者132例,心功能正常者168例,另根据NYHA分级将慢性心衰患者分为三组:Ⅱ级(n=54)、Ⅲ级(n=48)和Ⅳ级(n=30),分析各组血浆Hcy水平的差异及其与老年AECOPD并发慢性心衰的相关性。结果在老年AECOPD患者中,心衰组合并冠心病比率、合并糖尿病比率、合并高血压比率、合并脑梗塞比率、血浆Hcy水平和NT-pro BNP均高于心功能正常组,而LVEF低于心功能正常组(P <0.05);随着心功能级别升高,血浆Hcy水平和NT-pro BNP升高,而LVEF降低(P <0.05);Logistic回归分析提示血浆Hcy水平仍是老年AECOPD患者合并心衰的独立危险因素(OR=2.892,95%CI:1.983~3.725,P <0.05)。结论老年AECOPD患者合并心衰者血浆Hcy水平升高,且是老年AECOPD患者发生慢性心衰的独立危险因素。

Objective To explore the relationship between plasma homocysteine(Hcy)levels and the acute exacerbations of chronic obstructive pulmonary disease(AECOPD)combined with chronic heart failure(CHF)in elderly patients.Methods A total of 300 elderly patients with AECOPD were divided into CHF group(n=132)and normal heart function group(n=168).Patients with CHF in AECOPD were further divided into three subgroups of classⅡ(n=54),classⅢ(n=48)and classⅣ(n=30)according to NYHA grading of cardiac function.Differences of plasma Hcy levels and the relationship between plasma Hcy levels and CHF in elderly AECOPD patients were analyzed.Results In elderly patients with AECOPD,coronary heart disease percentage,diabetes percentage,cerebral infarction percentage,hypertension percentage,plasma Hcy levels and NT-proBNP and PaCO2 were significantly higher while LVEF were significantly lower in CHF group than in normal heart function group(P<0.05).In the CHF group,plasma Hcy levels and NT-proBNP increased while LVEF decreased with worsening of cardiac function(P<0.05).Logistic analysis showed that plasma Hcy level is an independent risk factor of CHD in elderly patients with AECOPD(OR=2.892,95%CI:1.983-3.725,P<0.05).Conclusion Plasma Hcy level will increase in elderly AECOPD patients combined with CHD.Plasma Hcy level may be an independent risk factors of CHD in elderly patients with AECOPD.