老年慢性心力衰竭患者血清C-肽的意义  

The Significance of Serum C-Peptide in Elderly Patients with Chronic Heart Failure

作　　者：李晓宗 胡燕 吴平 赵莲芳 黄秀英 李志强 Li Xiaozong;Hu Yan;Wu Ping;Zhao Lianfang;Huang Xiuying;Li Zhiqiang(Department of Clinical Laboratory,Pudong Hospital Affiliated to Fudan University,Shanghai,201399,P.R.China;Department of Emergency,Pudong Hospital Affiliated to Fudan University,Shanghai,201399,P.R.China;Department of Cardiology,Pudong Hospital Affiliated to Fudan University,Shanghai,201399,P.R.China)

机构地区：[1]复旦大学附属浦东医院检验科,上海201399 [2]复旦大学附属浦东医院急诊科,上海201399 [3]复旦大学附属浦东医院心血管内科,上海201399

出　　处：《老年医学与保健》2020年第2期208-211,223,共5页Geriatrics & Health Care

摘　　要：目的观察不同病因慢性心力衰竭(CHF)患者的空腹血清C-肽水平,探讨C-肽在CHF发病中的意义。方法2017年7月—2018年12月,选择180例不合并糖尿病的CHF住院患者为观察组,根据病因进一步分为冠心病(CHD)、高血压性心脏病(HHD)和心肌病(CM)3个亚组;60例无糖尿病和器质性心脏病的体检者为对照组。测定受试者血清总胆红素(TBIL)、谷丙转氨酶(ALT)、肌酐(Cr)、空腹血糖(FPG)、血脂、C反应蛋白(CRP)、白细胞计数(WBC)、血红蛋白(HB)、脑钠肽前体(Pro-BNP)、C-肽水平;记录血压、体质量指数(BMI)、左室射血分数(LVEF);评估纽约心脏学会(NYHA)心功能分级;询问吸烟和高血压病史。结果观察组FPG、CRP、Pro-BNP和C-肽水平高于对照组(均P<0.01),HB和LVEF低于对照组(均P<0.01),在3个亚组间C-肽水平差异无统计学意义(P>0.05)。观察组NYHA II级、III级、IV级间C-肽水平差异有统计学意义,NYHA IV级CHF患者、CHD患者、HHD患者和CM患者血清C-肽水平高于III级和II级患者(均P<0.01);NYHA III级CHF患者血清C-肽水平高于II级患者(P<0.05);CHD患者、HHD患者和CM患者血清C-肽水平在NYHA III级和II级间差异无统计学意义。Logistic回归分析显示,调整危险因素后,C-肽仍与CHF相关(P<0.05)。结论 CHF患者血清C-肽水平升高,且与心功能状况相关,C-肽可能与CHF的发生机制有关。Objective To observe the changes of serum C-peptide in chronic heart failure(CHF)patients with different causes,and investigate its significance in the pathogenesis of CHF.Methods From July 2017 to December 2018,180 CHF inpatients without diabetes mellitus were selected as the observation group,and they were further divided into three subgroups:coronary heart disease(CHD),hypertensive heart disease(HHD)and cardiomyopathy(CM)according to their etiology.60 subjects without diabetes and organic heart disease were enrolled as the control group.Serum total bilirubin(TBIL),alanine transarninase(ALT),creatinine(Cr),fasting plasma glucose(FPG),serum lipid,C-reaction protein(CRP),peripheral blood white blood cell(WBC)count,hemoglobin(HB),pro-brain natriuretic peptide(Pro-BNP),C-peptide concentration and blood pressure,body mass index(BMI),left ventricular ejection fraction(LVEF)of both groups were measured.Their New York Heart Association(NYHA)Cardiac Function Grade was evaluated and history of smoking and hypertension were investigated.Results The FPG,CRP,Pro-BNP and serum C-peptide concentrations of observation group were significantly higher than those of the control group(all P<0.01),the HB and LVEF were significantly lower than those of the control group(all P<0.01).The serum C-peptide level among the CHD,HHD and CM subgroups were not different significantly one another.The serum Cpeptide level among the NYHA II group,NYHA III group and NYHA IV group of CHF patients were different statistically one another(P>0.05).In the observation group,the serum C-peptide concentration in NYHA IV group were significantly higher than that in NYHA III group and NYHA II group(all P<0.01),and the serum C-peptide in NYHA III group was higher than that in NYHA II group(P<0.05);in the three subgroups,the serum C-peptide between NYHA II group and NYHA III group was not different significantly one another.Based on Logistic multiple regression analysis,the association of C-peptide with CHF was significant(P<0.05).Conclusion The level of ser

关 键 词：老年 慢性心力衰竭 C-肽 心功能 发病机制 

分 类 号：R541.6[医药卫生—心血管疾病]