老年慢性心力衰竭患者血尿酸和炎性因子水平变化及相关性分析

目的探讨老年慢性心力衰竭(CHF)患者血尿酸水平以及高敏C反应蛋白(hs CRP)、白细胞介素6(IL-6)、TNF-α等炎性因子水平的变化,并对其进行相关性分析。方法选择CHF患者65例(CHF组),根据心功能分级(NYHA),Ⅱ级15例,Ⅲ级32例,Ⅳ级18例;另选心功能正常的老年人45例(对照组)。所有入选者采用日本产OLYMPUS.AU5400全自动生化仪测定血尿酸、hs-CRP及血肌酐水平,采用放射免疫法测定lL-6、TNF-α水平,采用彩色多普勒超声测定左心室舒张末内径、左心房内径、LVEF、左心室二尖瓣舒张早期血流峰值和舒张晚期血流峰值比值。结果与对照组比较,CHF组心功能Ⅲ、Ⅳ级患者血尿酸、TNF-α、IL-6、hs CRP水平明显升高(P<0.01),并随心功能分级加重而增加。血尿酸水平与TNF-α、hs-CRP、IL-6等炎性因子呈正相关(r=0.74,r=0.60,r=0.68,P<0.01),而与LVEF呈负相关(r=-0.73,P<0.01)。结论老年CHF患者血尿酸水平显著升高,并与循环中的炎性因子密切相关,是CHF患者心功能恶化的重要预测指标。

Changes in levels of uric acid and inflammatory factors and analysis of their correlation in elderly patients with chronic heart failure

Objective To investigate the changes of serum uric acid(UA) levels and several inflammatory factors and the relationship between them in elderly patients with congestive heart failure (CHF).Methods Sixty-five elderly patients with CHF and 45 healthy volunteers(control group) were included in this study.In CHF group,15 were classified as New York Heart Association (NYHA) functional classⅡ,32 as classⅢand 18 as classⅣ.The serum UA,plasma creatinine, high-sensitivity C reactive protein(hs-CRP),interleukin 6(IL-6 ) and tumor necrosis factor-α(TNF-α) were measured,and echocardiography was performed.The relation between serum UA and these inflammatory factors,the relation between serum UA and cardiac structure and function were analyzed respectively.Results The levels of serum UA,IL-6,hs-CRP and TNF-αwere significantly higher in patients with NYHA functional classesⅢ—Ⅳthan in controls.There were positive correlations between serum UA and TNF-α,IL-6,hs-CRP(r = 0.74,r = 0.60,r = 0.68, P<0.01) and negative correlation between serum UA and LVEF(r =—0.73,P<0.01) in CHF group.Conclusions Serum level of UA is an important prognostic predictor in elderly patients with CHF and is paralleled with the chronic inflammatory response which occurs with increasing severity of CHF.