脂联素对慢性心力衰竭伴糖尿病患者的影响

目的：探讨脂联素与心力衰竭（心衰）患者心功能、前脑钠肽（pro-BNP）及高敏C反应蛋白（hs-CRP）等生化及生物标志物指标的相关性,以及脂联素与心衰尤其是合并糖尿病者预后的关系。方法：选择慢性心衰患者203例,分为伴有糖尿病组93例和不伴有糖尿病组110例。健康对照组60名。将患者全因死亡、猝死作为终点事件,随访1年,采用酶联免疫吸附法测定其血清脂联素、pro-BNP及hs-CRP水平。结果：心衰组脂联素水平较正常对照组明显升高（P〈0.01）,心衰伴糖尿病组较心衰不伴糖尿病组脂联素水平有所下降（P〈0.05）。体质量指数（BMI）、心功能分级、慢性肾功能不全、pro-BNP、三酰甘油（TG）及高密度脂蛋白（HDL）是脂联素水平的独立影响因素。脂联素是心衰病死率的独立预测因子（P〈0.05）。结论：慢性心衰患者血清脂联素水平明显升高,且与心衰严重程度（心功能分级）正相关,但伴有糖尿病者脂联素水平有所降低,脂联素是慢性心衰患者预后的独立预测因子。

Influence of adiponectin in chronic heart failure patients with diabetes mellitus

Objective To study the correlation between adiponectin and cardiac function , pro-brain natriuretic peptide （pro-BNP）, high sensitive C reactive protein （hs-CRP） and other biochemical or biological markers, and prognosis in patients with chronic heart failure （CHF）, especially those associated with diabetes mellitus （DM）. Methods Two hundred and three CHF patients were enrolled in this study, patients were divided into diabetes group （93 patients） and non- diabetes group （110 patients）. Sixty healthy subjects were served as normal control. The endpoint was defined as death from all causes and sudden death. All patients were followed for one year. Serum adiponectin, pro-BNP and hs-CRP were determined by enzyme linked immunosorbent assay. Results Serum adiponectin level in heart failure group was significantly higher than that in normal control group （ P〈0.01 ）; serum adiponectin was lower in heart failure associated with diabetes group when compared with not associated with diabetes group （ P〈0.05 ）. Body mass index （ BMI ）, cardiac function, chronic renal insufficiency, pro-BNP, triglyceride （ TG ） and high density lipoprotein （ HDL ） were independent influencing factors of serum adiponectin level. Adiponectin was an independent predictor of mortality for patients with CHF （ P〈0.05 ）. Conclusions Serum adiponectin level increased in patients with CHF, and correlated positively with severity of CHF; adiponectin level was decreased somewhat in those associated with diabetes . Adiponectin was an independent prognosis predictor of patients with CHF.