血清尿酸水平在慢性心力衰竭患者病程中的临床意义

目的 探讨血尿酸（UA）水平在慢性心力衰竭（CHF）患者病程中的意义.方法 260例CHF患者,按NYHA心功能分级分为Ⅱ、Ⅲ、Ⅳ级组,分别为82、80、98例;按UA水平分为UA正常组（144例）和UA增高组（116例）.所有入选患者入院时或急诊检查UA、肾功能、电解质、脑利钠肽（BNP）等项目;超声心动图测定心脏左室舒张末期内径（LVEDd）、左室后壁厚度（LVPWd）、室间隔厚度（IVSd）和左室射血分数（LVEF）,计算左心室质量指数（LVMI）.结果 心力衰竭患者血UA水平明显升高,发生率为44.6％.随着心功能损害的加重,高尿酸血症的发生率增加（x2=33.01,P＜0.01）,UA水平增高（F=15.853,P＜0.01）.血UA增高者LVEDd明显增大,LVMI增加,LVEF值显著降低,BNP明显上升（P＜0.01）.相关分析显示,LVMI与血UA水平呈正相关（r=0.295,P＜0.01）,LVEF与血UA水平呈负相关（r=-0.446,P＜0.01）,BNP与血UA水平呈正相关（r=0.404,P＜0.01）.结论 UA是CHF病变进展及严重程度的一个重要指标.

Clinical significance of serum uric acid level in the detection in patients with chronic heart failure

Objective To evaluate the association of the serum uric acid （UA） level with left ventricular Ultrasonic indicators,brain natriuretic peptides（BNP） in chronic heart failure（CHF）.Methods The total of 260 CHF patients were divided into 3 groups according to the New York Heart Association （NYHA） criteria.The number of NYHA Ⅱ-Ⅳ were 82,80,98 respectively.According to levels of serum UA,the patients were divided into two groups：normal UA group（n=144） and hyperuricemia group（n=116）.All the patients underwent the routine test（UA,BNP） and during the emergency disposal or the next moring after admissinn.They received echocardiography one week after admission.LVEDd,LVPEd,and EF were measured.LVMI was calculated by Devereux formula.Results CHF patients had a high level of UA.The incidence of hyperuricemia was 44.6%,correlated with the NYHA grades （x2=33.01,P〈0.01）.The level of serum UA was also correlated with the NYHA grades （F=15.853,P〈0.01）.In patients of hyperuricemia,the level of LVEDd,LVMI was higher,the value of EF was lower,the level of serum BNP were higher than in normal UA,Simple linear correlation confirmed that LVMI （r=0.295,P〈0.01）,LVEF （r=-0.446,P〈0.01）,BNP （r=0.404,P〈0.01）,are correlated with UA.Conclusion UA is an important indicator of aggravation and severity in CHF.