西南地区慢性心力衰竭患者血清总胆红素的变化
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摘要
目的:探讨中国西南地区慢性心力衰竭(CHF)患者血清总胆红素(TSB)变化特点。方法:回顾性研究中国西南地区云南省、贵州省、四川省、重庆市12家医院因CHF住院患者3 674例,剔除缺失数据患者,共2 692例患者进入研究,分析TSB水平与心功能级别、年龄、性别、B型脑钠肽(BNP)、左室射血分数(LVEF)、左室舒张末期内径(LVEDd)的关系。结果:CHF患者随着心功能的恶化,TSB水平升高(P<0.01),与心功能Ⅱ级组相比,心功能Ⅲ级组和心功能Ⅳ级组的TSB水平增高(P<0.01),与心功能Ⅲ级组相比,心功能Ⅳ级组的TSB水平增高(P<0.01)。不同射血分数CHF患者TSB水平有差异,射血分数降低的心力衰竭(HFrEF)组和射血分数中间值的心力衰竭(HFmrEF)组的TSB水平高于射血分数保留的心力衰竭(HFpEF)组(P<0.01),HFmrEF与HFrEF组TSB水平相近(P>0.05)。男性的TSB水平明显高于女性(P<0.01)。不同年龄组CHF患者的TSB水平各不相同,以青年组的TSB水平最高(P<0.01),中年组、年轻老年组、老年组之间TSB水平相近(P>0.05)。CHF患者TSB水平与LVEDd和BNP呈正相关,与LVEF呈负相关(P<0.01)。结论:CHF患者随着心功能恶化,TSB水平越高;青年患者TSB水平最高;男性的TSB水平明显高于女性;TSB水平与LVEDd和BNP呈正相关,与LVEF呈负相关。
Objective:To investigate the characteristic variations of serum total bilirubin(TSB) in patients with chronic heart failure(CHF) in Southwest of China.Method:The clinical dates of 3 674 patients with chronic heart failure(CHF) hospitalized in 12 hospitals of Yunnan Province,Guizhou Province,Sichuan Province and Chongqing City were collected.After excluded the dates with information missed,2 692 patients were enrolled in this study.Then we analyzed the relationship of TSB level and NYHA,class of heart function,age,sex,brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF) and left ventricular end-diastolic diameter(LVEDd).Result:With the heart function worsen,the TSB increased(P<0.01),TSB in NYHA class Ⅲ group and NYHA class Ⅳ group was significantly higher than that of NYHA class Ⅱ group(P<0.01).TSB in NYHA class Ⅳ group was significantly higher than that of NYHA class Ⅲ group(P<0.01).TSB was different in patients with different ejection fractions.TSB in HFrEF group and HFmrEF group were significantly higher than those in HFpEF group(P<0.01).TSB in HFmrEF group was similar to that in HFrEF group(P>0.05).TSB in male group was significantly higher than that in female group(P<0.01).TSB was different in patients with different ages.TSB in the youth group was the highest(P<0.01).However,TSB level in middle-aged group,young age group and elderly group were similar(P>0.05).TSB was positively correlated with LVEDd and BNP,and negatively correlated with LVEF(P<0.01).Conclusion:With the heart function worsen,the TSB of patients with chronic heart failure(CHF) increased;TSB in the youth group was the highest;TSB in male group was significantly higher than that in female group;TSB was positively correlated with LVEDd and BNP,and negatively correlated with LVEF.
Objective:To investigate the characteristic variations of serum total bilirubin(TSB) in patients with chronic heart failure(CHF) in Southwest of China.Method:The clinical dates of 3 674 patients with chronic heart failure(CHF) hospitalized in 12 hospitals of Yunnan Province,Guizhou Province,Sichuan Province and Chongqing City were collected.After excluded the dates with information missed,2 692 patients were enrolled in this study.Then we analyzed the relationship of TSB level and NYHA,class of heart function,age,sex,brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF) and left ventricular end-diastolic diameter(LVEDd).Result:With the heart function worsen,the TSB increased(P<0.01),TSB in NYHA class Ⅲ group and NYHA class Ⅳ group was significantly higher than that of NYHA class Ⅱ group(P<0.01).TSB in NYHA class Ⅳ group was significantly higher than that of NYHA class Ⅲ group(P<0.01).TSB was different in patients with different ejection fractions.TSB in HFrEF group and HFmrEF group were significantly higher than those in HFpEF group(P<0.01).TSB in HFmrEF group was similar to that in HFrEF group(P>0.05).TSB in male group was significantly higher than that in female group(P<0.01).TSB was different in patients with different ages.TSB in the youth group was the highest(P<0.01).However,TSB level in middle-aged group,young age group and elderly group were similar(P>0.05).TSB was positively correlated with LVEDd and BNP,and negatively correlated with LVEF(P<0.01).Conclusion:With the heart function worsen,the TSB of patients with chronic heart failure(CHF) increased;TSB in the youth group was the highest;TSB in male group was significantly higher than that in female group;TSB was positively correlated with LVEDd and BNP,and negatively correlated with LVEF.
引文
[1] 张健,张宇辉.多中心、前瞻性中国心力衰竭注册登记研究——病因、临床特点和治疗情况初步分析[J].中国循环杂志,2015,30(5):413-416.
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[4] 赵鑫,陈章荣,吴新华,等.云南地区慢性心力衰竭患者血尿酸变化特点 [J].临床心血管病杂志,2016,32(12):1232-1234.
[5] 吴华芹,李莹,张并璇,等.胆红素对老年慢性心力衰竭全因死亡风险的预测价值及其影响因素[J].临床心血管病杂志,2018,34(1):52-56.
[6] Zheng H,Li Y,Xie N.Association of serum total bilirubin levels with diastolic dysfunction in heart failure with preserved ejection fraction[J].Biol Res,2013,47(1):1-6.
[7] Allen LA,Felker GM,Pocock S,et al.Liver function abnormalities and outcome in patients with chronic heart failure:Data from the Candesartan in Heart Failure:Assessment of Reduction in Mortality and Morbidity (CHARM) program[J].Euro J Heart Fail,2014,11(2):170-177.
[8] Herzer K,Kneiseler G,Bechmann LP,et al.Onset of heart failure determines the hepatic cell death pattern[J].Ann Hepatol,2011,10(2):174-179.
[9] Jia R,Cao LP,Du JL,et al.Effects of carbon tetrachloride on oxidative stress,inflammatory response and hepatocyte apoptosis in common carp (Cyprinus carpio)[J].Aquat Toxicol,2014,152(152C):11-19.
[10] Zapelini PH,Rezin GT,Cardoso MR,et al.Antioxidant treatment reverses mitochondrial dysfunction in a sepsis animal model[J].Mitochondrion,2008,8(3):211-218.
[11] Lin JC,Peng YJ,Wang SY,et al.Role of the sympathetic nervous system in carbon tetrachloride-induced hepatotoxicity and systemic inflammation[J].Plos One,2015,10(3):1365-1374.
[12] Rogers FJ,Gundala T,Ramos JE,et al.Heart failure with preserved ejection fraction[J].J Am Osteop Associ,2015,115(7):432-442.
[13] 董海秋,董梅,任法新.雌激素水平对绝经后女性急性心肌梗死发生的影响研究[J].临床心血管病杂志,2017,33(2):56-59.
[14] Kao TL,Chen YL,Kuan YP,et al.Estrogen-estrogen receptor α signaling facilitates bilirubin metabolism in regenerating liver through regulating cytochrome P450 2A6 expression[J].Cell Trans,2017,26(11):1822-1829.
[15] 孙丽杰,张福春,李丹,等.总胆红素水平对住院性心力衰竭患者远期预后影响[J].中华内科杂志,2012,51(9):677-679.
[16] Lee SP,Kim HK,Kim YJ,et al.Association of myocardial angiogenesis with structural and functional ventricular remodeling in aortic stenosis patients with normal ejection fraction[J].J Cardiovasc Ultrasound.2014,22(2):72-79.
[17] Horsfall LJ,Nazareth I,Petersen I,et al.Cardiovascular events as a function of serum bilirubin levels in a large,statin-treated cohort[J].Circulation,2012,126(22):2556-2564.
[2] Samsky MD,Patel CB,Dewald TA,et al.Cardiohepatic interactions in heart failure:an overview and clinical implications[J].J Am Coll Cardiol,2013,61(24):2397-2405.
[3] 张健,邹长虹.《2016年欧洲心脏病学会急慢性心力衰竭诊断与治疗指南》非药物治疗部分解读[J].中国介入心脏病学杂志,2016,24(11):612-615.
[4] 赵鑫,陈章荣,吴新华,等.云南地区慢性心力衰竭患者血尿酸变化特点 [J].临床心血管病杂志,2016,32(12):1232-1234.
[5] 吴华芹,李莹,张并璇,等.胆红素对老年慢性心力衰竭全因死亡风险的预测价值及其影响因素[J].临床心血管病杂志,2018,34(1):52-56.
[6] Zheng H,Li Y,Xie N.Association of serum total bilirubin levels with diastolic dysfunction in heart failure with preserved ejection fraction[J].Biol Res,2013,47(1):1-6.
[7] Allen LA,Felker GM,Pocock S,et al.Liver function abnormalities and outcome in patients with chronic heart failure:Data from the Candesartan in Heart Failure:Assessment of Reduction in Mortality and Morbidity (CHARM) program[J].Euro J Heart Fail,2014,11(2):170-177.
[8] Herzer K,Kneiseler G,Bechmann LP,et al.Onset of heart failure determines the hepatic cell death pattern[J].Ann Hepatol,2011,10(2):174-179.
[9] Jia R,Cao LP,Du JL,et al.Effects of carbon tetrachloride on oxidative stress,inflammatory response and hepatocyte apoptosis in common carp (Cyprinus carpio)[J].Aquat Toxicol,2014,152(152C):11-19.
[10] Zapelini PH,Rezin GT,Cardoso MR,et al.Antioxidant treatment reverses mitochondrial dysfunction in a sepsis animal model[J].Mitochondrion,2008,8(3):211-218.
[11] Lin JC,Peng YJ,Wang SY,et al.Role of the sympathetic nervous system in carbon tetrachloride-induced hepatotoxicity and systemic inflammation[J].Plos One,2015,10(3):1365-1374.
[12] Rogers FJ,Gundala T,Ramos JE,et al.Heart failure with preserved ejection fraction[J].J Am Osteop Associ,2015,115(7):432-442.
[13] 董海秋,董梅,任法新.雌激素水平对绝经后女性急性心肌梗死发生的影响研究[J].临床心血管病杂志,2017,33(2):56-59.
[14] Kao TL,Chen YL,Kuan YP,et al.Estrogen-estrogen receptor α signaling facilitates bilirubin metabolism in regenerating liver through regulating cytochrome P450 2A6 expression[J].Cell Trans,2017,26(11):1822-1829.
[15] 孙丽杰,张福春,李丹,等.总胆红素水平对住院性心力衰竭患者远期预后影响[J].中华内科杂志,2012,51(9):677-679.
[16] Lee SP,Kim HK,Kim YJ,et al.Association of myocardial angiogenesis with structural and functional ventricular remodeling in aortic stenosis patients with normal ejection fraction[J].J Cardiovasc Ultrasound.2014,22(2):72-79.
[17] Horsfall LJ,Nazareth I,Petersen I,et al.Cardiovascular events as a function of serum bilirubin levels in a large,statin-treated cohort[J].Circulation,2012,126(22):2556-2564.
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