老年冠心病慢性心力衰竭患者血清同型半胱氨酸的变化  

Correlation between hyperhomocysteinemia and chronic heart failure secondary to coronary heart disease

作　　者：贾如意[1] 赵洁[1] 柳翠霞[1] 苑光盈[1] 王涛[1] 虞化鹏[1] 

机构地区：[1]济南市第四人民医院心内科济南市心血管病研究所,山东济南250031

出　　处：《心脏杂志》2010年第2期228-230,共3页Chinese Heart Journal

摘　　要：目的:研究同型半胱氨酸(HCY)与冠心病慢性心力衰竭(CHF)的关系。方法:57例冠心病CHF患者(组),按照心功能NYHA分级分为3个亚组:CHFⅡ级组、Ⅲ级组、Ⅳ级组;选择同期住院的无CHF的冠心病稳定型心绞痛(SAP)患者20例为SAP组;健康者20例作为健康对照组。所有观察对象均于住院次日清晨抽取空腹血测定同型半胱氨酸(HCY)、氮末端脑钠尿肽(NT-proBNP)。结果:①CHF组患者血HCY浓度显著高于SAP组,且二者均高于健康对照组。②CHF组患者随CHF分级的增加,HCY水平逐步增高。③CHF组患者HCY的增加与NT-proBNP的增加呈正相关(r=0.583,P<0.05)。④CHF患者中HCY与左室射血分数值呈负相关(r=-0.482,P<0.05),与左室舒张末内径呈正相关(r=0.561,P<0.05)。结论:高同型半胱氨酸血症与冠心病CHF有关。AIM： To study the correlation between the level of serum homocysteine （HCY） and chronic heart failure （CHF） in patients with coronary heart disease （CHD） and to observe the changes of HCY and CHF after short-term treatment with folic acid and vitamins B6 and B12. METHODS： Fifty seven patients with CHF secondary to CHD （ heart failure group） were divided into three subgroups according to NYHA cardiac function classification （ coronary heart failure Ⅱ, Ⅲ and Ⅳ groups）. Twenty patients who were diagnosed as having stable angina pectoris without heart failure were selected as CHD control group. Twenty healthy subjects served as control group. The levels of HCY and NT-proBNP were measured. RESULTS： Serum HCY in patients with CHF was higher than in patients with stable angina pectoris and the levels in both CHF group and CHD group were higher than in the healthy control group. In the group with CHF, serum HCY increased with the increase of NYHA cardiac function classification （P 〈 0. 05）. Serum HCY and NT-proBNP were positively correlated. In the CHF group, serum HCY and EF were negatively correlated but serum HCY and LVEDD were positively correlated. After short-term treatment with folic acid and vitamins B6 and BI2, levels of HCY and NT-proBNP decreased. CONCLUSION： HCY is associated with CHF in patients with CHD. Serum HCY may participate in the pathogenesis of CHF and may be one of the independent risk factors for heart failure.

关 键 词：冠状动脉疾病 心力衰竭 慢性 同型半胱氨酸 氯末端脑钠肽 

分 类 号：R714.246[医药卫生—妇产科学] R541.61[医药卫生—临床医学]