高密度脂蛋白浓度与冠状动脉粥样硬化性心脏病合并心力衰竭患者预后的关系  

Relationship between concentration of high-density lipoprotein and prognosis of patients with coronary heart disease complicating with heart failure

作　　者：陈津[1] 李希大 蔡安平[1] 钟琪[1] 李敏明[1] 王锐[1] 周颖玲[1] 黎励文[1] 

机构地区：[1]广东省心血管病研究所心内科广东省冠心病防治研究重点实验室广东省人民医院(广东省医学科学院),广州510080

出　　处：《岭南心血管病杂志》2016年第5期503-508,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的评估高密度脂蛋白(high-density lipoprotein,HDL)浓度与冠状动脉粥样硬化性心脏病(冠心病)合并射血分数降低心力衰竭(ejection fraction reduced heart failure,EFr HF)患者预后的相关性并探讨其机制。方法回顾性分析广东省人民医院2013至2015年323例冠心病合并EFr HF患者的临床资料,将其分为高HDL浓度组和低HDL浓度两组,对两组的临床资料进行比较以及评估HDL浓度与患者预后的关系。结果与低HDL浓度组比较,高HDL浓度组血浆脂蛋白浓度较高,谷氨酸-丙酮酸转氨酶、高敏C反应蛋白浓度较低,而白蛋白浓度较高,差异有统计学意义(P<0.05)。两组射血分数比较,差异无统计学意义(28.8%±4.5%vs.28.4%±4.6%,P=0.358)。高HDL浓度组病死率比低HDL浓度组低,差异有统计学意义(43.5%vs.59.1%,P=0.007)。HDL浓度与白蛋白浓度呈正相关,与谷丙转氨酶、高敏C反应蛋白浓度及纽约心脏协会(NYHA)心功能分级呈负相关。使用多因素校正后的Logistic回归分析显示,高HDL浓度与全因病死率降低具有明显相关性。结论高HDL浓度与冠心病合并心力衰竭患者的全因病死率减少具有相关性。Objectives To evaluate the relationship and mechanisms of concentration of high-density lipoprotein （HDL） and prognosis of patients with coronary heart disease complicating with ejection fraction leduced heart failure （EFrHF）. Methods Clinical data of 323 patients from Guangdong General Hospital were retrospectively studied. According to the concentration of HDL, patients were divided into high concentration of and low concentration of HDL groups. Clinical data between the two groups were compared and relationship between concentration of HDL and prognosis of patients with coronary heart disease complicating with EFrHF were evaluated. Results Concentrations of lipoprotein and albumin in high concentration of HDL group were significantly higher, and concentrations of alanine aminotransferase （ALT） and high-sensitivity C-reactive protein （Hs-CRP） were lower as compared to low concentration of HDL group （P〈0.05）. There was no significant difference in left ventricular ejection fraction （LVEF） between high and low concentration of HDL groups （28.8 %±4.5% vs. 28.4%＋4.6%, P= 0.358）, while mortality rate in high concentration of HDL group was lower （43.5% vs. 59.1%, P=0.007）. Concentration of HDL was positively related to albumin concentration, and negatively related to ALT, hs-CRP and cardiac function. After adjusted for potential eovariates, concentration of HDL was significantly associated with lower all-cause mortality. Conclusions Higher concentration of HDL is associated with lower rate of all-cause mortality.

关 键 词：心力衰竭 胆固醇 炎症 预后 

分 类 号：R541.6[医药卫生—心血管疾病]