血浆高同型半胱氨酸水平与扩张型心肌病慢性心衰相关研究

目的:探讨血浆同型半胱氨酸水平与扩张型心肌病慢性心力衰竭(扩心病心衰)的关系。方法:选取扩心病心衰患者65例,正常人30例。检测血浆同型半胱氨酸浓度、血浆B型利钠肽浓度、多普勒超声心动图仪测量左室舒张末期内径和左室射血分数,比较扩心病心衰组与对照组血浆同型半胱氨酸水平差异,观察扩心病血浆同型半胱氨酸水平与心功能分级、B型利钠肽、左室舒张末期内径、左室射血分数关系。结果:(1)扩心病心衰组高同型半胱氨酸血症检出率高于对照组(47.69%vs 13.33%,P<0.05),同型半胱氨酸平均水平高于对照组(20.13±5.94μmol/L vs10.28±3.98μmol/L,P<0.05)。(2)随着心衰分级增加同型半胱氨酸平均水平逐渐增高,其水平在各心功能亚组间有显著差异(P<0.05)。(3)扩心病心衰组同型半胱氨酸与B型利钠肽(r=0.595,P<0.05)、左室舒张末期内径呈正相关(r=0.476,P<0.05),与左室射血分数呈负相关(r=-0.421,P<0.05)。结论:扩张型心肌病慢性心力衰竭患者血浆同型半胱氨酸水平明显升高,高同型半胱氨酸血症的检出率高,随心衰分级的增加同型半胱氨酸平均水平逐渐增高。血清同型半胱氨酸水平与B型利钠肽、左室舒张末期内径呈正相关,与左室射血分数呈负相关,是影响扩心病心脏结构和功能的一个危险因素。

The correlative study between the levels of serum homocysteine and chronic heart failure secondary to primary dilated cardiomyopathy

Objective：To explore the relationship between the levels of serum homocysteine（HCY） and chronic heart failure（CHF）secondary to primary dilated cardiomyopathy（DCM）.Methods：All subjects consisted of 65 patients with chronic heart failure secondary to primary dilated cardiomyopathy（DCMHF） and 30 cases of normal controls.By measuring the levels of HCY and BNP and determining LVEDD and LVEF by Echocardiography,the differences of the levels of HCY between the two groups were compare,and the correlation of serum HCY with NYHA cardiac function classification,LVEDD,LVEF and BNP was observed.Results： 1.The prevalence rate of homocysteinemia was higher in DCMHF group（47.69%vs 13.33%,P0.05）.The average level of serum HCY in the DCMHF group was higher than that in the control group（20.13±5.94μmo/l vs 10.28±3.98μmol/l,P0.05）.2.The serum HCY was increased with the cardiac function classification.The levels of HCY in the three subgroups according to NYHA cardiac function classification had significant difference in statistics（P0.05）.3.In DCMHF group,the level of HCY and LVEF were determined with negative linear correlation（r=-0.421,P0.05）,HCY and BNP were determined with positive linear correlation（r=0.595,P0.05）,and HCY and LVEDD were determined with positive linear correlation（r=0.476,P0.05）.Conclusions： The prevalence rate of HHCY in the DCMHF group was higher than that in the control group.The average level of serum HCY in the DCMHF group was higher than it in the control group.HCY was increased with the NYHA cardiac function classification in the DCMHF group,and the level of serum HCY was associated with the severity degree of the cardiac function.The levels of HCY and LVEF were determined with negative linear correlation,BNP and LVEDD with positive linear correlation.Serum homocysteine level is a risk factor that affects cardiovascular structures and functions of DCM.