2021 年第 8 期 第 16 卷

慢性心力衰竭患者左心室射血分数与血尿酸和N末端B型脑钠肽前体等指标的关系

Relationship between left ventricular ejection fraction and serum uric acid, N-terminal pro-brain natriuretic peptide and other indexs in patients with chronic heart failure

作者：褚国洁张立晶李蒙郑相颖闫康佳刘用刘碧绒林鼎峰

英文作者：Chu Guojie Zhang Lijing Li Meng Zheng Xiangying Yan Kangjia Liu Yong Liu Birong Lin Dingfeng

单位：北京中医药大学东直门医院心血管内科100007

英文单位：Department of Cardiology Dongzhimen Hospital Beijing University of Chinese Medicine Beijing 100007 China

关键词：慢性心力衰竭；左心室射血分数；血尿酸；N末端B型脑钠肽前体；纽约心脏病协会心功能分级；左心室舒张末期内径；左心室收缩末期内径

英文关键词：Chronicheartfailure;Leftventricularejectionfraction;Serumuricacid;N-terminalpro-brainnatriureticpeptide;NewYorkHeartAssociationcardiacfunctionclassification;Leftventricularenddiastolicdiameter;Leftventricularendsystolicdiameter

• 摘要：

• 目的 分析慢性心力衰竭（CHF）患者左心室射血分数（LVEF）与血尿酸、N末端B型脑钠肽前体（NT-proBNP）、纽约心脏病协会（NYHA）心功能分级、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）的关系。方法 回顾性分析2020年6月至2021年1月在北京中医药大学东直门医院进行治疗的CHF患者99例，按照LVEF不同分为射血分数保留型心力衰竭（HFpEF）组（LVEF≥50%，48例）、射血分数中间值型心力衰竭（HFmrEF）组（LVEF 40%～49%，32例）、射血分数降低型心力衰竭（HFrEF）组（LVEF＜40%，19例）。比较3组患者血尿酸、NT-proBNP、NYHA心功能分级、LVEDD、LVESD的水平，分析以上5种指标与LVEF的相关性。结果 HFpEF组患者血尿酸、LVEDD、LVESD均显著低于HFmrEF组、HFrEF组［（379±109）μmol/L比（451±165）、（561±156）μmol/L；（47±6）mm比（53±6）、（64±8）mm；（31±6）mm比（41±5）、（55±8）mm］,且HFmrEF组患者血尿酸、LVEDD、LVESD均显著低于HFrEF组（均P＜0.05）。3组患者NYHA心功能分级差异有统计学意义（P＜0.001）。HFpEF组NT-proBNP水平低于HFrEF组（P＜0.05）。相关性分析结果显示，血尿酸、NT-proBNP、LVEDD、LVESD、NYHA心功能分级与LVEF均呈负相关（r=-0.486、P＜0.001；r=-0.279、P=0.005；r=-0.728、P＜0.001；r=-0.869、P＜0.001；r=-0.290、P=0.004）。结论 在临床中，我们可通过检测血尿酸、NT-proBNP、NYHA心功能分级、LVEDD、LVESD等指标对CHF患者LVEF进行综合判断，为疾病的发展、治疗及预后提供有效评估依据。

• Objective To analyze the relationship between left ventricular ejection fraction(LVEF) and serum uric acid, N-terminal pro-brain natriuretic peptide (NT-proBNP), New York Heart Association (NYHA) cardiac function classification, left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) in patients with chronic heart failure (CHF). Methods From June 2020 to January 2021, 99 patients with CHF admitted to Dongzhimen Hospital, Beijing University of Chinese Medicine were retrospectively analyzed. According to the LVEF, they were divided into heart failure with preserved ejection fraction (HFpEF) group (LVEF ≥50%, 48 cases), heart failure with mid-range ejection fraction (HFmrEF) group (LVEF as 40%-49%, 32 cases) and heart failure with reduced ejection fraction (HFrEF) group (LVEF ＜40%, 19 cases). The levels of serum uric acid, NT-proBNP, NYHA cardiac function classification, LVEDD and LVESD levels were compared among the three groups, and the correlation between the above five indexes and LVEF was analyzed. Results The levels of serum uric acid, LVEDD and LVESD in HFpEF group were significantly lower than those in HFmrEF group and HFrEF group［（379±109）μmol/L vs （451±165）,（561±156）μmol/L；（47±6）mm vs （53±6）,（64±8）mm；（31±6）mm vs （41±5）,（55±8）mm］, and the levels of serum uric acid, LVEDD and LVESD in HFmrEF group were significantly lower than those in HFrEF group (all P＜0.05). There was significant difference in NYHA cardiac function classification among the three groups (P＜0.001). The level of NT-proBNP in HFpEF group was lower than that in HFrEF group (P＜0.05). Correlation analysis showed that serum uric acid, NT-proBNP, LVEDD, LVESD and NYHA cardiac function classification were negatively correlated with LVEF(r=-0.486, P＜0.001； r=-0.279, P=0.005； r=-0.728, P＜0.001； r=-0.869, P＜0.001； r=-0.290, P=0.004). Conclusion In clinical practice, detecting serum uric acid, NT-proBNP, NYHA cardiac function classification, LVEDD, LVESD and other indicators can comprehensively judge LVEF of patients with CHF, so as to provide an effective evaluation basis for the development, treatment and prognosis of the disease.