慢性充血性心衰患者心功能与血尿酸水平相关性研究

目的　研究慢性充血性心衰患者心功能与血尿酸水平的相关性。方法　选择稳定的心衰患者179例 ,予正规的抗心衰治疗 ,排除房颤患者 ,对患者进行生化全套检查 ,同时进行心脏多普勒检查 ,测量E峰速度、A峰速度 ,E/A比值 ,E峰减速时间 (EDT)。左室收缩末及舒张末内径 ,左室射血分数 (LVEF) ,和心输出量 (SV)。以E/A >2或E/A >1和EDT <14 0ms为限制性二尖瓣充盈形式 (RMFP) ,将患者分为RMFP组和非RMFP组 ,比较两组的血尿酸差异 ,并判断与心功能的关系。结果　RMFP组患者的尿酸 (μmol/L)为 377 32±130 4 7,NRMFP组患者的尿酸为 30 7 72± 12 4 6 1,两者比较有显著差异 (P <0 0 5 ) ,心功能Ⅰ ,Ⅱ ,Ⅲ ,Ⅳ级之间尿酸依次升高 ,但仅Ⅳ级分别与Ⅰ ,Ⅱ ,Ⅲ级比较 ,两两之间有显著差异 ,从血尿酸和收缩参数LVEF ,SV ,CO之间的相关系数来看 ,血尿酸和收缩参数LVEF之间存在负相关 ,即血尿酸越高 ,LVEF越低 ,(P <0 0 5 ) ,排除其它因素后 ,血尿酸和LVEF的相关系数为 - 2 92 2 ,P <0 0 1。结论　升高的血尿酸与慢性充血性心衰患者的收缩和舒张功能有显著的相关性 ,从理论上提示黄嘌呤氧化酶的抑制剂可能有利于改善心衰患者的心功能。

Study of Relationship between Chronic Heart Failure and Serum Uric Acid level

Objective To assess whether serum uric acid might correlate with left ventricular systolic and diastolic dysfunction in patients with chronic heart failure (CHF). Methods Study included 179 inpatients with CHF. On the day of study, fasting venous blood samples were drawn for routine laboratory tests including serum uric acid. At the same time patients underwent a complete echo-dopple examination measuring of mitral E wave and mitral A wave velocities, E/A radio, E wave deceleration time (EDT), left ventricular diameteer of end-systolic and end-diastolic, ejection fraction (LVEF) and stroke volume (SV). A restrictive mitral filling pattern (RMFP) was defined as either E/A>2 or E/A>1 and EDT<140ms. Results 28 patients had a RMFP. Patients with RMFP had significantly higher uric acid level compared with patients without RMFP (377.32±130.47 vs 307.72±124.61,P<0.05). There was negative correlation between uric acid level and LVEF (r=-2.922,P<0.01). Conclusions Elevated uric acid level is associated with not only systolic dysfunction but also diastolic dysfunction in CHF. Xanthine oxydase inhibition in patients with CHF might theoretically result in improvement of heart dysfunction.