扩张型心肌病患者血清尿酸浓度的动态变化

目的探讨扩张型心肌病(DCM)心力衰竭(心衰)患者血清尿酸浓度的变化规律及其临床意义。方法比较DCM(46例)不同心功能状态下尿酸浓度；比较22例DCM心衰控制前后的尿酸浓度；比较DCM中左室内径≥65mm(26例)和＜65mm(16例)患者的尿酸浓度；比较DCM入院时未用利尿剂及正在服用利尿剂患者的尿酸浓度；比较DCM中血尿素氮＞7.5(18例)和≤7.5mmol/L(28例)患者的尿酸浓度。结果DCM心功能Ⅱ、Ⅲ、Ⅳ级的尿酸分别为(303±34)、(403±95)和(595±190)mmol/L；心衰控制前后尿酸浓度为〔(609±218)和(414±147)mmol/L(P＜0.01)〕；左室内径≥65mm者尿酸明显高于＜65mm者；入院时服与未服利尿剂者尿酸无明显差异(P＞0.05)；血尿素氮＞7.5与≤7.5mmol/L者尿酸浓度无明显差别(P＞0.05)。结论DCM心衰患者尿酸浓度增高，独立于服用利尿剂及肾功能不全，且随着心衰加重而明显增高，是反映心衰患者病情严重程度的一个指标。

The dynamic changes ofserum uric acid and its clinical implications in patients with idiopathic dilatedcardiomyopathy

Objective:To assess the change rules and clinical implications of increased serum uric in patients with idiopathic dilated cardiomyopathy (IDC).Method:The studied population consisted of 46 patients with IDC.Serum uric acid was assessed in the following groups:① Forty-six patients with different severity of heart failure;②Twenty-two cases before and after the control of heart failare;③Left ventricular internal diameter (LVID) ≥ or ＜65 mm(n=26, 16, respectively);④Patients with and without diuretic therapy;⑤Twenty-eight patients with blood urea nitrogen ＞ or ≤7.5 mmol/L.Result:The concentration of serum uric acid in patients NYHA functional class Ⅱ、Ⅲ、Ⅳ was (303±34), (403±95) and (595±190) mmol/L respectively.Serum uric acid wass (609±218) and (414±147) mmol/L before/after stabilization of heart failure (P＜0.01).It was much higher in patients whose LVID≥65 mm as compared to those LVID＜65 mm (572±182 vs 425±112, P＜0.01).There was no difference between the patients who received diuretics or not (533±21 vs 501±16, P＞0.05).BUN also did not influence serum uric acid.Conclusion:The increased serum uric acid is associated with deterioration of heart failure in patients with IDC and independent of diuretics therapy or renal function insufficiency.It is a predicator of the severity of heart failure.