射血分数正常的心力衰竭患者血清胆红素水平与舒张功能不全的相关性研究  

The relation study between serum bilirubin and diastolic cardiac dysfunction in heart failure with preserved ejection fraction patients

作　　者：袁博[1] 任晖[1] 巩洁[1] 李静[1] 郑时康[1] 王甲文[1] 王蕊[1] 高天林[1] 

机构地区：[1]陕西省安康市中心医院心血管内科,725000

出　　处：《疑难病杂志》2015年第10期1003-1006,共4页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨射血分数正常的心力衰竭(HFpEF)患者血清胆红素水平与舒张功能不全的相关性。方法 2014年1—12月诊治HFpEF患者80例为HFpEF组,根据超声检查结果分为3个亚组:轻度亚组13例、中度亚组44例、重度亚组23例,另选取健康体检者30例为健康对照组。通过心脏超声测量左房内径、左室舒张末期内径、左室短轴缩短率、左室射血分数、左室舒张末期容积、E峰、A峰、舒张早期二尖瓣环运动速度,并计算E/Ea值。综合统计分析胆红素水平与心脏超声各项结果的关系。结果中度亚组和重度亚组HFpEF患者总胆红素(TB)和直接胆红素(DB)均明显高于健康对照组(TB:t_(中度)=1.732,P=0.045;t_(重度)=2.032,P=0.025。DB:t_(中度)=2.732,P=0.007;t_(重度)=2.036,P=0.026),HFpEF患者组内比较可见,重度亚组HFpEF患者血清TB和DB明显低于轻度亚组(TB:t=1.715,P=0.047;DB:t=2.032,P=0.024)。HFpEF组患者Ea峰明显低于健康对照组(t=0.010,P=0.017),而E/Ea高于健康对照组(t=0.022,P=0.032)。重度亚组患者Ea峰和E/Ea均明显差于轻度亚组(Ea峰:t=2.079,P=0.023;E/Ea:t=2.411,P=0.011)。TB及DB水平与E/Ea呈负相关(r=-0.401,P=0.040;r=-0.434,P=0.030)。通过多元逐步回归分析表明,血清TB水平可作为自变量能分别进入E峰(P=0.003)和Ea峰(P=0.003)为因变量的线性回归模型方程。结论胆红素水平与心室舒张功能密切相关,可能是影响HFpEF发生机制中的重要危险因素。Objective To investigate the correlation between serum bilirubin level and diastolic dysfunction in pa -tients with heart failure （HFpEF） with normal ejection fraction.Methods From 2014 January to 2014 December, 80 patients with HFpEF were enrolled .According to the results of ultrasound examination , patients were divided into 3 subgroups：mild subgroup with 13 cases, moderate sub group with 44 cases, severe sub group with 23 cases, 30 cases of healthy physical ex-amination were selected as healthy control group .Left atrial diameter , left ventricular end diastolic diameter , left ventricular ejection fraction, left ventricular end diastolic volume , E peak, A peak, early diastolic mitral annular velocity were measured by echocardiography , and E/Ea values were calculated .The relationship between bilirubin level and cardiac ultrasound and the results of echocardiography were analyzed .Results Moderate sub group and severe subgroups ’ total bilirubin （ TB） and direct bilirubin （DB） were significantly higher than those of healthy control group （TB in moderate subgroups：t =1.732, P =0.045;TB in severe sub group：t =2.032, P =0.025.DB in moderate subgroups：t =2.732, P =0.007;TB in severe sub group：t =2.036, P =0.026）, comparison within HFpEF group, severe HFpEF subgroup’s serum TB and dB was sig-nificantly lower than that of the mild sub group （TB：t =1.715, P =0.047;DB：t =2.032, P =0.024）.HFpEF group’s EA peak was significantly lower than that in healthy control group （ t =0.010, P =0.017） and E /EA was higher than that of healthy control group （ t =0.022, P =0.032）.Severe subgroup’s EA peak and E /EA were significantly lower than mild sub group （EA peak：t =2.079, P =0.023;E /EA：t =2.411, P =0.011）.A negative correlation between TB and DB levels and E/Ea were existed （ r =-0.401, P =0.040;r =-0.434, P =0.030）.By multivariate stepwise regression analysis showed that serum level of TB can be as an independent variable into e peak （ P =0.003 ） and EA pea

关 键 词：胆红素 心力衰竭 保留射血分数的舒张功能 临床意义 

分 类 号：R541.6[医药卫生—心血管疾病]