摘要
目的分析血清同型半胱氨酸(Hcy)、甲硫氨酸(Met)和半胱氨酸(Cys)与慢性心力衰竭(CHF)的相关性及诊断价值。方法连续纳入2018年10月至2019年9月大连大学附属中山医院178例CHF急性加重期患者(CHF组)和70例健康体检者(健康对照组)。CHF组中,射血分数降低的心力衰竭(HFrEF)53例,射血分数中间值的心力衰竭(HFmrEF)50例,射血分数保留的心力衰竭(HFpEF)75例。采用串联质谱法检测血清Hcy、Met和Cys;电化学发光免疫技术检测血清N末端脑钠肽前体(NT-proBNP);超声心动图检测左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)和二尖瓣口舒张早期血流峰值速度与二尖瓣环舒张早期运动峰值速度比值(E/e′),计算左心室射血分数(LVEF)。相关性采用Pearson相关分析。绘制受试者工作特征(ROC)曲线,利用曲线下面积(AUC)评价血清Hcy、Met、Cys、NT-proBNP、LVEF诊断CHF的效能。结果CHF组Hcy、Met、Cys、NT-proBNP、LVEDd和E/e′明显高于健康对照组[(12.64±5.02)μmol/L比(8.71±3.47)μmol/L、(23.38±5.75)μmol/L比(20.52±4.18)μmol/L、(343.45±44.49)μmol/L比(290.53±48.38)μmol/L、(5759.43±3806.22)pg/L比(40.24±31.91)pg/L、(52.67±12.27)mm比(46.41±12.27)mm和(17.32±5.61)%比(9.54±2.64)%],LVEF明显低于健康对照组[(45.27±4.93)%比(62.37±5.41)%],差异有统计学意义(P<0.01或<0.05)。HFmrEF和HFrEF患者血清Hcy和Cys明显高于HFpEF患者[(16.29±8.18)和(18.68±8.99)μmol/L比(13.75±6.48)μmol/L、(346.64±51.85)和(361.40±52.34)μmol/L比(329.35±55.16)μmol/L],差异有统计学意义(P<0.05);HFmrEF患者与HFrEF患者比较差异无统计学意义(P>0.05)。HFrEF患者血清Met明显高于HFpEF和HFmrEF患者[(28.74±8.22)μmol/L比(24.76±7.60)和(25.15±6.96)μmol/L],差异有统计学意义(P<0.05);HFpEF患者与HFmrEF患者比较差异无统计学意义(P>0.05)。Pearson相关性分析结果显示,Hcy、Met、Cys与NT-proBNP呈正相关(r=0.632、0.206和0.455,P<0.01),与E/e′水平呈�
Objective To analyze the correlation and diagnostic value of serum homocysteine(Hcy),methionine(Met)and cysteine(Cys)in patients with chronic heart failure(CHF).Methods One hundred and seventy-eight patients with acute decompensation CHF(CHF group)and 70 healthy persons(healthy control group)from October 2018 to September 2019 in Affiliated Zhongshan Hospital of Dalian University were continuously enrolled.In CHF group,heart failure with reduced ejection fraction(HFrEF)was in 53 cases,heart failure with mid-range ejection fraction(HFmrEF)was in 50 cases,and heart failure with preserved ejection fraction(HFpEF)was in 75 cases.Serum levels of Hcy,Met and Cys were detected by tandem mass spectrometry.Serum level of N-terminal brain natriuretic peptide precursor(NT-proBNP)was detected by electrochemical luminescence immunity.The left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd)and early diastolic peak blood flow velocity of mitral valve annulus/early diastolic peak velocity of mitral annulus(E/e′)were detected by echocardiography,then left ventricular eject fraction(LVEF)was calculated.Correlation was analyzed by Pearson correlation analysis.The receiver operator characteristic(ROC)curve was drawn,and the area under curve(AUC)was used to evaluate the efficacy of serum Hcy,Met,Cys,NT-proBNP and LVEF in the diagnosis of CHF.Results The Hcy,Met,Cys,NT-proBNP,LVEDd and E/e′in CHF group were significantly higher than those in healthy control group:(12.64±5.02)μmol/L vs.(8.71±3.47)μmol/L,(23.38±5.75)μmol/L vs.(20.52±4.18)μmol/L,(343.45±44.49)μmol/L vs.(290.53±48.38)μmol/L,(5759.43±3806.22)pg/L vs.(40.24±31.91)pg/L,(52.67±12.27)mm vs.(46.41±12.27)mm and(17.32±5.61)%vs.(9.54±2.64)%,the LVEF was significantly lower than that in healthy control group:(45.27±4.93)%vs.(62.37±5.41)%,and there were statistical differences(P<0.01 or<0.05).The Hcy and Cys in patients with HFmrEF and HFrEF were significantly higher than those in patients with HFpEF:(16.29±8.18)and(18
作者
向姝婷
曹雅兰
王钰
赵高娃
肖何柳
张斯琪
黄思琪
于勤
Xiang Shuting;Cao Yalan;Wang Yu;Zhao Gaowa;Xiao Heliu;Zhang Siqi;Huang Siqi;Yu Qin(Zunyi Medical University Graduate School,Zunyi 563000,China;Dalian Medical University Graduate School,Dalian 116044,China;Dalian University Graduate School,Dalian 116622,China;Affiliated Zhongshan Hospital of Dalian University,Dalian 116001,China;Department of Circulation in Affiliated Zhongshan Hospital of Dalian University,Dalian 116001,China)
出处
《中国医师进修杂志》
2020年第7期585-589,共5页
Chinese Journal of Postgraduates of Medicine
基金
国家自然科学基金 (81770405)。
