摘要
【目的】探讨血浆总胆固醇水平与急性左心衰患者预后相关性及其机制。【方法】通过前瞻性方法,入选68例急性左心衰发作患者,收集基线资料及其相关实验室指标;出院后对其随访1个月;依据患者是否发生心血管终点事件分为有事件组和无事件组,对两组进行比较,同时进行Logistic回归分析血浆总胆固醇水平与心血管终点事件相关性。【结果】本研究患者平均年龄为(57.3±12.6)岁,男性52例(76.5%);其中46例既往有冠心病(67.6%),10例有风湿性心脏病(14.7%),12例有扩心病(17.7%);38例有高血压(55.9%),24例有糖尿病(35.3%)。随访1月时,共有39例患者发生心血管终点事件(57.4%),其中36例因心衰再入院,3例因心衰死亡。与有事件组患者相比,无事件组患者年龄较小,吸烟所占人数比例较少(P<0.05);无事件组患者血浆N端脑利钠肽和C反应蛋白水平较低(P<0.05);而血浆总胆固醇和白蛋白水平较高(P<0.05)。出院带药两组患者间无明显差别。采用Logistic回归分析血浆总胆固醇水平与心血管终点事件相关性,在校正年龄、性别、吸烟、收缩压、血浆白蛋白、糖尿病、高血压、药物后,血浆总胆固醇水平升高对心血管终点事件具有保护作用(优势比OR为0.91,95%置信区间0.80-0.96);进一步校正血浆C反应蛋白后,血浆总胆固醇水平升高对心血管终点事件保护作用不再具有统计学意义(优势比OR为0.97,95%置信区间0.87-1.09)。【结论】血浆适当总胆固醇水平对急性左心衰患者短期预后具有保护作用,其机制可能与适度水平胆固醇能够提供能量和营养支持,改善炎症反应有关。
[Objective ] The present study was to evaluate the association of serum total cholesterol level and prognosis in patients with acute left heart failure and associated mechanisms. [ Methods ] Sixty-eight patients due to acute episode of left heart failure prospectively enrolled, and baseline data and biochemical parameters were collected. After discharge, patients were follow-up for 1 month and they were divided into two groups （with and without cardiovascular events ）. Differences between groups were evaluated and the association of serum total cholesterol level and cardiovascular events were analyzed by logistic regression analysis. [ Results ] The mean age was 57.3 ± 12.6 years old and 52 cases were male patients accounting for 76.5 %. Among these patients, 46 had a diagnosis of coronary heart disease （67.6 %）, 10 rheumatic heart disease （ 14.7 %）, 12 dilated cardiomyopathy （ 17.7%）, 38 hypertension （55.9%） and 24 diabetes mellitus （35.3%）. After 1 month＇s follow up, 39 patients （57.4%） had experienced cardiovas- cular events, 36 cases were re-hospitalized, and 3 died from heart failure. Compared to those with cardiovascular events, event free individuals were younger and were less likely smokers （P 〈 0.05）. In addition, event free group had lower serum levels of N-terminal pro-BNP and C-reactive protein （P 〈 0.05） while serum levels of total cholesterol and albumin were significantly higher （P 〈 0.05 ）. There was no significant difference in medication between these two groups. After adjusted for age, gender, smoking, systolic blood pressure, serum albumin level, diabetes, hypertension and medications, increased total cholesterol level was independently associat- ed with better prognosis with odds ratio of 0.91 （95 % confidence interval 0.80-0.96）. Further adjusted for C-reactive protein, the as- sociation was attenuated to non-significance, with odds ratio of 0.97 （95 % confidence interval 0.87-1.09）. [Conclusion] Adequate serum total cholesterol level
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2017年第4期556-560,共5页
Journal of Sun Yat-Sen University:Medical Sciences
基金
广东省深圳市科技计划项目(JCYJ20160427174117767)
关键词
胆固醇
急性左心衰
炎症反应
cholesterol
acute left heart failure
inflammation
