慢性心力衰竭患者ALT、Cr水平变化及与心功能分级的关系
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摘要
目的探讨慢性心力衰竭(CHF)患者丙氨酸氨基转移酶(ALT)、肌酐(Cr)水平变化及其与心功能分级的关系。方法选取2015年3月至2018年3月收治的CHF患者200例,依据纽约心脏协会(NYHA)心功能分级分为Ⅱ级组(n=60例)、Ⅲ级组(n=76例)、Ⅳ级组(n=64例),同期选取体检中心健康人员50例作为健康组,检测所有人员ALT、Cr、N末端B型利钠肽原(NT-BNP)、左心室射血分数(LVEF)水平。结果Ⅳ级组NT-BNP和ALT、Cr及其异常率明显高于Ⅲ级组,Ⅲ级组NT-BNP和ALT、Cr及其异常率率明显高于Ⅱ级组,Ⅱ级组NT-BNP和ALT、Cr及其异常率明显高于健康组,Ⅳ级组LVEF明显低于Ⅲ级组,Ⅲ级组LVEF明显低于Ⅱ级组,Ⅱ级组LVEF明显低于健康组,差异有统计学意义(P<0.05);Pearson相关性分析结果显示,ALT、Cr与NT-BNP呈正相关,ALT、Cr与LVEF呈负相关(P<0.05)。结论 CHF患者多存在肝肾功能损伤,随着心功能分级的升高,肝肾功能损伤加剧,ALT、Cr水平变化对CHF心功能具有一定的评估价值。
Objective To explore the the changes of alanine aminotransferase(ALT) and creatinine(Cr) levels in patients with chronic heart failure(CHF) and their relationship with cardiac function classification.Methods A total of 200 patients with CHF, who were treated from March 2015 to March 2018, were divided into Ⅱ class group(n=60), Ⅲ class group(n=76) and Ⅳ class group(n=64) according to the cardiac functional grading of New York Heart Association(NYHA). Meanwhile, fifty healthy persons from medical examination center were selected as health group. The ALT, Cr, N terminal B type natriuretic peptide(NTBNP) and left ventricular ejection fraction(LVEF) of the four groups were detected.Results The levels of NTBNP and ALT, Cr and their abnormality rate in Ⅳ class group were significantly higher than those in Ⅲ class group. The levels of NTBNP and ALT, Cr and their abnormality rate in Ⅲ class group were significantly higher than those in Ⅱ class group and the levels of NTBNP and ALT, Cr and their abnormality rate in Ⅱ class group were significantly higher than those in health group. Moreover, the levels of LVEF in Ⅳ class group were significantly lower than those in Ⅲ class group. The levels of LVEF in Ⅲ class group were significantly lower than those in Ⅱ class group and the levels of LVEF in Ⅱ class group were significantly lower than those in health group(P<0.05). In addition, the Pearson correlation analysis showed that the ALT and Cr were positively correlated with NTBNP and negatively correlated with LVEF, respectively(P<0.05).Conclusion The liver and kidney function injury is very common in patients with CHF, which will aggravate with the increase of cardiac function classification. The changes of ALT and Cr levels are helpful in evaluating the cardiac function of CHF.
Objective To explore the the changes of alanine aminotransferase(ALT) and creatinine(Cr) levels in patients with chronic heart failure(CHF) and their relationship with cardiac function classification.Methods A total of 200 patients with CHF, who were treated from March 2015 to March 2018, were divided into Ⅱ class group(n=60), Ⅲ class group(n=76) and Ⅳ class group(n=64) according to the cardiac functional grading of New York Heart Association(NYHA). Meanwhile, fifty healthy persons from medical examination center were selected as health group. The ALT, Cr, N terminal B type natriuretic peptide(NTBNP) and left ventricular ejection fraction(LVEF) of the four groups were detected.Results The levels of NTBNP and ALT, Cr and their abnormality rate in Ⅳ class group were significantly higher than those in Ⅲ class group. The levels of NTBNP and ALT, Cr and their abnormality rate in Ⅲ class group were significantly higher than those in Ⅱ class group and the levels of NTBNP and ALT, Cr and their abnormality rate in Ⅱ class group were significantly higher than those in health group. Moreover, the levels of LVEF in Ⅳ class group were significantly lower than those in Ⅲ class group. The levels of LVEF in Ⅲ class group were significantly lower than those in Ⅱ class group and the levels of LVEF in Ⅱ class group were significantly lower than those in health group(P<0.05). In addition, the Pearson correlation analysis showed that the ALT and Cr were positively correlated with NTBNP and negatively correlated with LVEF, respectively(P<0.05).Conclusion The liver and kidney function injury is very common in patients with CHF, which will aggravate with the increase of cardiac function classification. The changes of ALT and Cr levels are helpful in evaluating the cardiac function of CHF.
引文
1 王正中,王丽,蒲毅,等.心力衰竭患者血浆BNP、NT-BNP及cTnI水平的变化及其诊断价值研究.国际检验医学杂志,2017,38:1283-1286.
2 曹佳佳,陈旭,刁增利,等.慢性心力衰竭患者肝肾功能损害与NT-pro-BNP相关性分析.慢性病学杂志,2014,15:519-522.
3 Louie CY,Pham MX,Daugherty TJ,et al.The liver in heart failure:a biopsy and explant series of the histopathologic and laboratory findings with a particular focus on pre-cardiac transplant evaluation.Mod Pathol,2015,28:932-943.
4 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南.中华心血管病杂志,2007,35:1076-1095.
5 李志强,王春燕,石毅,等.慢性心力衰竭患者血红蛋白清道夫受体CD163的表达及意义.岭南心血管病杂志,2018,24:60-65.
6 Valbusa F,Agnoletti D,Scala L,et al.Non-alcoholic fatty liver disease and increased risk of all-cause mortality in elderly patients admitted for acute heart failure.Int J Cardiol,2018,S0167-5273:30544-30548.
7 Christensen HM,Kistorp C,Schou M,et al.Cross-talk betweenthe heart and adipose tissue in cachectic heart failure patientswith respect to alterations in body composition:a prospectivestudy.Metabolism,2014,63:141-149.
8 Heo S,Moser DK,Lennie TA,et al.Modifiable correlates of physical symptoms and health-related quality of life in patients with heart failure:a eross-sectional study.Int J Num Stud,2014,51:1482-1492.
9 温建艳,吴晓燕,程雅洁,等.急性左心衰竭和充血性心力衰竭患者肝功能生化指标差异的临床观察.中国生化药物杂志,2017,37:298-300.
10 Stammberger HR,Kenney DW.Paranasal sinuses:anatomic terminologyand nomenclature.Ann Oto Rhinol Laryngol,2014,167:7-16.
11 李文安,刘凯,江帆,等.急性失代偿性心力衰竭患者血清碱性磷酸酶与肾功能恶化的相关性研究.中国全科医学,2018,21:818-821.
12 Go AS,Hsu CY,Yang J,et al.Acute kidney injury and risk of heart failure and atherosclerotic events.Clin J Am Soc Nephrol,2018,13:833-841.
13 陈茂连.血清心型脂肪酸结合蛋白水平与慢性心力衰竭的关系研究.中医临床研究,2017,9:15-17.
14 柳森,王莉,刘旭.肝脏功能和生化指标对心力衰竭程度及预后的预测价值.心血管病学进展,2015,36:227-230.
15 余波,艾芬,张利芸.重组人脑利钠肽对老年急性失代偿性心力衰竭病人临床疗效及血清NT-pro BNP、Copeptin水平的影响.实用老年医学,2017,31:476-478.
16 Anand IS.High-output heart failure revisited.J Am Coll Cardiol,2016,68:483-486.
17 Pita-Fernández S,Chouci?o-Fernández T,Juega-Puig J,et al.A randomized clinical trial to determine the effect of angiotensin inhibitors reduction on creatinine clearance and haemoglobin in heart failure patients with chronic kidney disease and anaemia.Int J Clin Pract,2014,68:1231-1238.
2 曹佳佳,陈旭,刁增利,等.慢性心力衰竭患者肝肾功能损害与NT-pro-BNP相关性分析.慢性病学杂志,2014,15:519-522.
3 Louie CY,Pham MX,Daugherty TJ,et al.The liver in heart failure:a biopsy and explant series of the histopathologic and laboratory findings with a particular focus on pre-cardiac transplant evaluation.Mod Pathol,2015,28:932-943.
4 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南.中华心血管病杂志,2007,35:1076-1095.
5 李志强,王春燕,石毅,等.慢性心力衰竭患者血红蛋白清道夫受体CD163的表达及意义.岭南心血管病杂志,2018,24:60-65.
6 Valbusa F,Agnoletti D,Scala L,et al.Non-alcoholic fatty liver disease and increased risk of all-cause mortality in elderly patients admitted for acute heart failure.Int J Cardiol,2018,S0167-5273:30544-30548.
7 Christensen HM,Kistorp C,Schou M,et al.Cross-talk betweenthe heart and adipose tissue in cachectic heart failure patientswith respect to alterations in body composition:a prospectivestudy.Metabolism,2014,63:141-149.
8 Heo S,Moser DK,Lennie TA,et al.Modifiable correlates of physical symptoms and health-related quality of life in patients with heart failure:a eross-sectional study.Int J Num Stud,2014,51:1482-1492.
9 温建艳,吴晓燕,程雅洁,等.急性左心衰竭和充血性心力衰竭患者肝功能生化指标差异的临床观察.中国生化药物杂志,2017,37:298-300.
10 Stammberger HR,Kenney DW.Paranasal sinuses:anatomic terminologyand nomenclature.Ann Oto Rhinol Laryngol,2014,167:7-16.
11 李文安,刘凯,江帆,等.急性失代偿性心力衰竭患者血清碱性磷酸酶与肾功能恶化的相关性研究.中国全科医学,2018,21:818-821.
12 Go AS,Hsu CY,Yang J,et al.Acute kidney injury and risk of heart failure and atherosclerotic events.Clin J Am Soc Nephrol,2018,13:833-841.
13 陈茂连.血清心型脂肪酸结合蛋白水平与慢性心力衰竭的关系研究.中医临床研究,2017,9:15-17.
14 柳森,王莉,刘旭.肝脏功能和生化指标对心力衰竭程度及预后的预测价值.心血管病学进展,2015,36:227-230.
15 余波,艾芬,张利芸.重组人脑利钠肽对老年急性失代偿性心力衰竭病人临床疗效及血清NT-pro BNP、Copeptin水平的影响.实用老年医学,2017,31:476-478.
16 Anand IS.High-output heart failure revisited.J Am Coll Cardiol,2016,68:483-486.
17 Pita-Fernández S,Chouci?o-Fernández T,Juega-Puig J,et al.A randomized clinical trial to determine the effect of angiotensin inhibitors reduction on creatinine clearance and haemoglobin in heart failure patients with chronic kidney disease and anaemia.Int J Clin Pract,2014,68:1231-1238.