慢性心力衰竭患者血浆谷胱甘肽抗氧化系统的变化及意义

目的研究慢性心力衰竭（CHF）患者血浆谷胱甘肽抗氧化系统的改变及其临床意义。方法选择2006年1月至2006年9月收住我院心内科慢性心力衰竭的住院患者53例为观察组，门诊体检健康者25例为对照组。按NYHA心功能分级将CHF组分为心功能Ⅱ级组（n=11例），心功能Ⅲ级组（n=15例），心功能Ⅳ级组（n=27例）。所有患者均于入院后第2天采空腹静脉血，应用酶循环法测定血浆还原型谷胱甘肽（GSH）、氧化型谷胱甘肽（GSSG）浓度，根据Nemst公式计算氧化还原电位（EhGSH/GSSG）。结果①CHF组血浆GSH浓度较对照组明显下降（5．23±0．77）umol／L VS（6．52±1．02）umol]L，P〈0．05）；CHF组血浆GSSG浓度高于对照组（1．51±0．24）umol／L vs（1．16±0．53）umol／L，P〈0．05，CHF组EhGSH/GSSG值较对照组升高（-122．92±4．37）mV vs（-133．67±3．49）mV，P〈0．05。②CHF各亚组患者血浆GSH浓度、GSSG浓度、EhGSH/GSSG值在心功能Ⅱ级组与Ⅲ、Ⅳ级组之间有显著性差异（P〈0．05），Ⅲ、Ⅳ级组之间无差异。结论心衰时存在氧化应激，机体的抗氧化作用减弱；血浆GSH浓度、GSSG浓度及EhGSH/GSSG值均与心功能存在相关性，可作为反映心功能的指标。

The changes and clinical significance of glutathione redox-state in chronic heart failure patients

Objective To research the change and clinical significance of glutathione redox-state in chronic heart failure （CHF） patients, nethords Total of 53 hospitalized patients as observed group and 25 healthy people as control group were selected. According to NYHA heart function grade, the CHF group were classfied into 3 subgroups Ⅱ, Ⅲ, Ⅳ grade. Samples of peripheral venous blood with heparin as anticoagulant were obtained from aforesaid patients on empty stomach in morning, then the sample were centrifuged and the plasma concentration of GSH and GSSG was determined by using glutathione reductase recycling method. Redox potential EhGSH/GSSG was calculated using Nemst equation according to the concentration of reduced and oxidized glutathione. Results ①The concentration of GSH was significantly lower in CHF group compared with control group, while the concentration of GSSG and the value of EhGSH/GSSG were higher in GHF group. ②There was a significant difference between heart function grade Ⅱ and Ⅲ, Ⅳ in CHF subgroups in concentration of GSH, GSSG and value of EhGSH/GSSG but there was no difference between the grade Ⅲ and Ⅳ subgroups. Conclusion ①There had an oxidative stress in CHF patients and an imbalance in antioxidation and proxidation in the progression of CHF. ②Plasma concentration of GSH, GSSG, and the value EhGSH/GSSG all had a correlation with the heart function,may be used as a marker to reflect heart function and the serious degree of CHF.