心脏病患者血清铜、锌、锰、铬、硒含量测定的临床意义

作者应用原子吸收光谱法和原子荧光光谱法测定了人血清铜、锌、锰、铬、及全血硒。测定对象分正常对照(40例),冠心病(36例),风湿性心脏瓣膜病(27例),扩张型心肌病(34例)4组。结果表明,正常人平均血铜值1.227±0.213μg/ml,锌1.0±0.149μg/ml,铬8.945±5.464ng/ml,锰12.163±4.21ng/ml,硒0.0625±0.03μg/ml,与文献报道值接近。其余三组心脏病人血铜值(1.448μg/ml,1.740μg/ml、1.746μg/ml)均显著升高(P<<0.001),血锌在冠心病、风心病组降低(P<0.01),铬三组无变化,锰仅在风心病组降低(P<0.01),硒在冠心病组增高(P<0.05),在扩张型心肌病组则显著降低(P<0.0001)。急性心肌梗塞(13例),血铜升高,而锌降低;心衰时血铜显著升高。以上变化对三种心脏病及急性心肌梗塞的诊断与鉴別、判断心脏的功能可能有一定意义。特别是扩张型心肌病呈现出特异性血硒降低,可能是该病的致病因素之一。

CLINICAL SIGNIFICANCE OF SERUM ZINC, COPPER,MANGANESE, CHROMIUM AND SELENIUM INHEART DISEASES

Serum zinc, copper, mananese, chromium and blood selenium were measured by atomic absorption spectrophotometry and atomic fluorescence spec-trophotometry.137 subjects were divided into 4 groups which consisted of 40 normal controls. 36 coronary arteries diseases (including 13 cases of AMI, 7 cases of congestive heart failure); 27 rheumatic valvular heart diseases (including 19 cases of congestive-heart failure) and 34 dilated cardiomyopathy (including 17 cases of congestive heart failure). The results showed that the mean value of serum copper, zinc, chromium, manganese and blood selenium in 40 healthy adults was 1.227±0.213μg/ml, 1.0±0.149μg/ml, 8.945±5.464ng/ ml, 12.163±4.21ng/ml, 0.0625±0.03μg/ml, respectively. The serum levels of copper in three groups with heart diseases were significantly higher than in normal control (P<0.001); zinc levels in rheumatic valvular heart diseases and coronary arteries diseases were significantly lower than in healthy adults (P<0.001, P<0.05 respectively); In comparison with normal persons, no significant difference in serum chromium was observed in all of the heart diseases (P>0.05). The manganese in rheumatic valvular heart diseases was significantly lower than in normal control (P<0.01). The blood selenium concentration increased in coronary arteries diseases (P<0.05), while in dilated cardiomyopathy significant decrease was found (P<0.0001).Significant decrease in serum zinc and significant increase in serum copper were observed in 13 patients with AMI (P<0.05, P<0.01 respectively). No significant difference was found between patients with angina pectoris and normal controls.As described above, alterations in blood concentration of trace elements may have diagnostic values for heart diseases. The decrease of blood selenium concentration may be considered as a cause of dilated cardiomyopathy, because selenium is a component of glutathione peroxidase (GSH-Px) which protects the myocardial cells from injury.