摘要
目的观察同型半胱氨酸与冠心病心力衰竭及其严重程度的关系;观察短期应用叶酸与维生素B6、维生素B12进行干预治疗,同型半胱氨酸以及心力衰竭的变化。方法57例冠心病心力衰竭的患者(简称冠心病心衰组),按照心功能NYHA分级分为三个亚组:冠心病心功能Ⅱ级组、Ⅲ级组、Ⅳ级组;选择同期住院的无心力衰竭的冠心病稳定型心绞痛患者20例作为冠心病对照组;健康者20例作为健康组对照组。所有观察对象均于住院次日及叶酸和维生素B6、维生素B12治疗2周后清晨抽取空腹血测定同型半胱氨酸、氮末端脑钠素。结果①冠心病心衰组患者伴有高同型半胱氨酸血症的比例明显高于冠心病对照组和健康对照组。②冠心病心衰组患者血同型半胱氨酸浓度显著高于冠心病对照组,且二者均高于健康对照组。③冠心病心衰组患者随心力衰竭分级的增加,同型半胱氨酸水平逐步增高。④冠心病心衰组患者随心力衰竭分级增加氮末端脑钠素也逐渐增加,且同型半胱氨酸的增加与氮末端脑钠素的增加具有正相关关系(r=0.583,P<0.05)。⑤冠心病心衰患者中同型半胱氨酸与射血分数值呈负相关关系(r=-0.482,P<0.05),与左心室舒张末期内径呈正相关关系(r=0.561,P<0.05)。⑥经叶酸及维生素B6、维生素B12治疗后同型半胱氨酸与氮末端脑钠素均降低,治疗前后差异具有统计学意义(P<0.05)。结论高同型半胱氨酸血症与冠心病心衰有关,可能是心力衰竭的独立危险因素之一。冠心病心衰患者同型半胱氨酸,氮末端脑钠素水平随着心力衰竭分级的增加而逐渐升高,二者具有直线相关性,同型半胱氨酸可能参与心力衰竭的发展过程。同型半胱氨酸随心力衰竭的好转而降低,与心力衰竭的预后有关。
Aim To observe the correlation between the level of serum homocysteine and the heart failure in patients with coronary heart diseases and the severity of heart failure. Meanwhile the interventional treatment of folic acid and vitamin B6, B12 were given to the heart failure patients to observe the changes of HCY and the heart failure after the short-term therapy. Methods All 57 patients with chronic heart failure secondary to coronary heart diseases（heart failure group） were divided into three subgroups according to NYHA cardiac function classification （abbreviated as coronary, heart function Ⅱ, Ⅲ, Ⅳ groups）. Twenty patients who Were diagnosed as stable angina pectoris without heart failure were selected as coronary heart disease control group（CHD control group）. 20 healthy subjects after examination served as healthy control group. The levels of HCY and NT-proBNP were measured. Results①The prevalence rate of hyperhomocysteinemia （HHCY） was higher in chronic heart failure group than that in CHD control group and the healthy control group.②The serum HCY in patients with chronic heart failure disease were higher than that in stable angina pectoris patients and both higher than that in the healthy people.③In heart failure group the serum HCY were increased with the NYHA cardiac function classification increase（P〈0.05）.④The serum HCY and NT-proBNP was positive linear correlation.⑤In heart failure group, the serum HCY and EF were determined with negative linear correlation; the serum HCY and LVEDD were determined with negative linear correlation.⑥After short-term treated with folic acid, vitamin B6 and B12, the levels of HCY and NT-proBNP were both decreased. Conclusion HHCY are associated with heart failure and maybe one of the independent risk factors of heart failure. The level of HCY is increased with the severity degree of the cardiac function and the serum HCY may participate in the development of heart failure. Both levels of HCY and NT-proBNP seem to be related with the prognosis of heart failure.
出处
《中国动脉硬化杂志》
CAS
CSCD
北大核心
2009年第4期301-304,共4页
Chinese Journal of Arteriosclerosis
关键词
冠心病
心力衰竭
同型半胱氨酸
氮末端脑钠肽
Coronary Heart Disease
Chronic Heart Failure
Homocysteine
N-Terminal Portion of Brain Natriuretic
