血浆同型半胱氨酸对慢性心力衰竭患者的作用及意义

目的 通过观察慢性心力衰竭患者血同型半胱氨酸(Hcy)与B型利钠肽(BNP)的相关性,进一步探讨 测定血Hcy水平对于慢性心力衰竭患者的作用及意义。方法 入选了151例慢性心力衰竭患者作为心力衰竭组,其 中男93例,女58例,年龄27~92岁,平均(66.7±11.6)岁,所有入选患者均抽取空腹肘静脉血,测定血Hcy水平、 BNP浓度、血脂、血糖等。同时入选同期住院的249例心功能正常的患者作为对照组。结果 ①心力衰竭组的血 Hcy水平明显高于对照组(19.90±5.07)μmol/Lvs(14.84±4.87)μmol/L(P <0.01);心力衰竭组的血BNP浓度 明显高于对照组(1851.67±742.59)ng/Lvs(197.52±84.46)ng/L(P <0.01);②血Hcy、BNP随心功能分级的增 加而增加,差异有统计学意义(P <0.01);③血Hcy与BNP呈显著正相关(r =0.629,P <0.01);④Logistic回归分 析显示:高血压(OR =1.826,95%CI =1.021~3.266,P <0.05)、糖尿病(OR =1.716,95%CI =1.020~2.887, P <0.05)、高脂血症(OR =1.856,95%CI =1.015~3.396,P <0.05)、吸烟(OR =1.952,95%CI =1.233~ 3.089,P <0.05)、Hcy(OR =3.743,95%CI =2.271~6.169,P <0.01)为慢性心力衰竭患者的危险因素;⑤血 Hcy诊断慢性心力衰竭的ROC 曲线参数分析显示:AUC 为0.754,95%CI =0.706~0.802,P <0.01,临界值为 17.75μmo/L,敏感度为66.20%,特异度为73.90%。结论 血Hcy为慢性心力衰竭患者的独立危险因素,且临界值, 可作为慢性心力衰竭的新的诊断指标。

Effect and significance of plasma homocysteine in patients with chronic heart failure

ObjectiveTo investigate the role of plasma homocysteine and its clinical significance in chronic heart failure patients by observing the relationship of plasma homocysteine (Hcy) and B type natriuretic peptide (BNP).MethodsA total of 151 chronic heart failure patients including 93 males and 58 females， average age （66.7±11.6） years were investigated，and 249 patients with normal cardiac function at the same time of hospitalization served as control group.Plasma Hcy， BNP，lipids， blood glucose were studied.Results①The plasma Hcy concentration in heart failure patients was significantly higher than control group (19.90±5.07) μmol/L vs (14.84±4.87) μmol/L(P<0.01);The serum BNP concentration in heart failure patients was significantly higher than control group (1 851.67±742.59) ng/L vs (197.5±84.5) ng/L(P<0.01). ② The plasma Hcy and BNP were different from New York Heart Association (NYHA) classes (P<0.01). ③ The plasma Hcy and BNP were linear positive correlation (r=0.629，P<0.01). ④The results of logistic regression showed that hypertension (OR=1.826，95%CI=1.021 3.266，P<0.05），diabetes (OR=1.716，95%CI=1.020 2.887，P<0.05)，hyperlipidemia (OR=1.856，95%CI=1.015 3.396，P<0.05)，smoking (OR=1.952，95%CI=1.233 3.089，P<0.05)，Hcy(OR=3.743，95%CI=2.271 6.169，P<0.01) were risk factors for patients with chronic heart failure.⑤Receiver operating characteristic curve analysis indicated the cut off of Hcy for chronic heart failure was 17.75 μmo/L (ROC area under curve: 0.754，95%CI=0.706 0.802，P<0.01) with 73.90% specificity and 66.20% sensitivity.ConclusionHcy is an independent risk factor for chronic heart failure， and the cut of value can be used as a new diagnostic index for chronic heart failure.