老年慢性心功能不全血清尿酸、C反应蛋白的变化分析

徐继双

[摘要] 目的 分析老年慢性心功能不全血清尿酸、C反应蛋白的变化。 方法 选取我院2013年1月～2016年1月收治入院的慢性心功能不全患者100例作为观察组，其中心功能Ⅱ级30例，Ⅲ级34例，IV级36例。另选择我院同期健康体检者100例作为对照组，测定两组C反应蛋白（CRP）、血清尿酸（UA）、脑钠肽（BNP）水平，同时比较两组左心室射血分数（LVEF）情况。 结果 慢性心功能不全组患者血清UA、BNP和CRP水平均明显高于对照组，差异均有统计学意义（均P<0.05）。而LVEF明显低于对照组，且比较差异有统计学意义（P<0.05）；Ⅲ、IV级患者血清UA、BNP和CRP水平均明显高于Ⅱ级患者，且比较差异有统计学意义（P<0.05），而LVEF明显低于Ⅱ级患者，且比较差异有统计学意义（P<0.05）；IV级患者血清UA、BNP和CRP水平均明显高于Ⅲ级患者，且比较差异有统计学意义（P<0.05），而LVEF明显低于Ⅲ级患者，且比较差异有统计学意义（P<0.05）；相关性分析显示血清UA、LVEF与心功能分级呈显著的正相关（r1=0.624，r2=0.658，均P<0.05），而BNP、CRP与心功能分级无相关性（P>0.05）。 结论 血清UA、LVEF与心功能分级呈显著的正相关，而BNP、CRP与心功能分级无相关性。

[关键词] 慢性心功能不全；老年；血清尿酸；C反应蛋白

[中图分类号] R541 [文献标识码] A [文章编号] 2095-0616（2017）06-142-03

[Abstract] Objective To analyze the changes of serum uric acid and C-reactive protein in elderly patients with chronic heart failure. Methods 100 patients with chronic heart failure cured in our hospital from January 2013 to January 2016 were selected as observation group. There were 30 cases of grade II， grade III， grade， grade IV in 36 cases. C reactive protein （CRP）， serum uric acid （UA） and brain natriuretic peptide （BNP） of the two groups were measured. The left ventricular ejection fraction （LVEF） was also measured between the two groups. Results The levels of serum UA， BNP and CRP in patients with chronic heart failure in observation group were significantly higher than those in the control group （P<0.05）. The levels of serum UA， BNP and CRP in grade Ⅲ and IV patients were significantly higher than those in gradeⅡ patients （P<0.05）， and the difference was statistically significant （P<0.05）. The levels of serum UA， BNP and CRP in grade IV patients were significantly higher than those in grade Ⅲ patients， and the difference was statistically significant （P<0.05）. LVEF was significantly lower than that of grade Ⅱ patients， and the difference was statistically significant （P<0.05）. LVEF was significantly lower than that of grade Ⅲ （P<0.05）. Correlation analysis showed that serum UA and LVEF were positively correlated with cardiac function grade （r1=0.624， r2=0.658， all P<0.05）， but there was no correlation between BNP， CRP and cardiac function grade （P>0.05）. Conclusion Serum UA and LVEF are positively correlated with cardiac function grade， but there is no correlation between BNP and CRP and cardiac function grade.

[Key words] Chronic heart failure； Senile； Uric acid； C-reactive protein

心力衰竭又被稱作心功能不全，指的是任何原因导致的心肌结构和功能的改变引起心脏的充盈受限或泵血功能减弱。心力衰竭的发生发展过程非常复杂，包括了神经激素分泌异常、心肌缺血和细胞因子分泌异常等机制[1]。慢性心功能不全是多种心脏疾病长期进展的结局，是临床常见病和多发病。慢性心衰往往会导致继发性左心房扩大，从而引起心房颤动。房颤易导致心腔内血流动力学异常，使心衰和房颤的发病中起到了关键作用[2]，抑制炎性反应血栓发生率明显增高，脑栓塞等不良心、脑血管事件发有助于控制疾病进展[3]。目前已有诸多研究证实了血清尿酸（UA）和C-反应蛋白（CRP）在慢性心力衰竭的发展过程中起着重要作用，甚至成为引起心力衰竭患者死亡的独立危险因素[4]。本研究旨在探讨CHF患者血清尿酸（UA）和C-反应蛋白（CRP）变化的临床意义，为临床判断心衰患者的严重程度和指导治疗提供依据。……