心力衰竭患者血浆硫化氢水平变化及其临床意义

Changes of the Plasma Hydrogen Sulfide in Patients with Heart Failure and its Clinical Significance

目的观察心力衰竭（HF）患者血浆硫化氢（H2S）水平的变化,并探讨其临床意义。方法选取HF患者100例（心衰组）,健康体检者30例（正常对照组）,心衰组按美国纽约心脏病协会（NYHA）心脏功能分级分为NYHAⅡ级组35例、Ⅲ级组32例、Ⅳ级组33例;按左室射血分数（LVEF）水平分为LVEF<40%组52例和LVEF≥40%组48例。ELISA法检测血浆H2S与B型利钠肽（BNP）浓度,超声心动图检测LVEF、左室舒张末期内径（LVDd）、收缩末期内径（LVDs）及左室短轴缩短率（LVFS）,并分析H2S与BNP、NYHA分级及超声心动图指标之间的相关性。结果与正常对照组相比,心功能ⅡⅣ级组的BNP、LVDd、LVDs呈升高趋势,H2S、LVEF、LVFS呈降低趋势。正常对照组、LVEF≥40%组和LVEF<40%组的BNP、LVDd、LVDs依次升高,而H2S、LVEF、LVFS依次降低,组间多重比较均有统计学意义（P<0.05）;Pearson相关性分析显示,血浆H2S与BNP、NYHA、LVDd、LVDs呈负相关（r=-0.749、-0.544、-0.361、-0.388,P<0.01）,与LVEF、LVFS呈正相关（r=0.429、0.412,P<0.01）。结论 HF患者血浆H2S水平明显降低,提示与心功能密切相关,它可能参与了HF的发生和发展过程。

Objective To detect the changes of the plasma hydrogen sulfide in patients with heart failure（ HF） and to explore its clinical significance. Methods The subjects were divided into heart failure group and normal control group. The heart failure group were divided into heart function Ⅱgrade（ n = 35）,III grade（ n = 32） and Ⅳ grade（ n = 33） in accordance with New York Heart Association（ NYHA） and in accordance with left ventricular ejection fraction（ LVEF） CHF group were divided into LVEF < 40% group（ n = 52） and LVEF≥40% group（ n = 48）. The plasma hydrogen sulfide level and BNP were detected by ELISA. The LVEF,LVFS,left ventricular end-diastolic diameter（ LVDd）,left ventricular systolic diameter（ LVDs） were detected by Echocardiography. The correlation of H2S,the BNP,NYHA and index of echocardiography were analyzed. Results Compared with the control group,the BNP,LVDd and LVDs were substantially increased and the H2S,LVEF,LVFS substantially declined in NYHAⅡ to NYHA Ⅳ group. The BNP,LVDD and LVDs increased sequentially while H2S,LVEF and LVFS declined in the control group, LVEF < 40% group and LVEF≥40% group. Multiple comparisons between groups were statistically significant differences（ P < 0. 05）. Using Pearson correlation analysis,the plasma H2S was negatively correlated with BNP,NYHA,LVDd,LVDs（ r =-0. 749,-0. 544,-0. 361,-0. 388,P < 0. 01）,and was positively correlated with LVEF and LVFS（ r = 0. 429,0. 412,P < 0. 01）. Conclusion The decrease of the level of plasma hydrogen sulfide is closely related to the severity of heart failure. It may participate in the development process of patients with heart failure.