慢性心力衰竭患者血清趋化素水平变化及临床意义
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摘要
目的探讨慢性心力衰竭(CHF)患者血清趋化素(Chemerin)水平变化及临床意义。方法选取2013年9月至2017年12月于首都医科大学附属北京安贞医院收治的CHF患者93例为研究组。根据纽约心脏协会(NYHA)心功能分级将研究组患者分为Ⅱ级组28例,Ⅲ级组31例,Ⅳ级组34例。另选取同期住院的心律失常非CHF患者30例为对照组。检测并比较对照组与研究组、不同NYHA心功能分级的血清Chemerin水平,心功能指标包括左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD),心室重构指标,包括平均室壁应力(MWS)、左心室质量指数(LVMI)。采用Pearson相关性分析血清Chemerin水平与心功能指标、心室重构指标间的相关性。结果研究组患者血清Chemerin水平、LVEDD、MWS及LVMI均显著高于对照组患者,LVEF显著低于对照组,组间比较差异有统计学意义(P<0.05)。研究组不同NYHA心功能分级的Chemerin水平、心功能指标、心室重构指标整体比较差异均有统计学意义(P<0.05);Chemerin、LVEDD、MWS、LVMI随心功能分级的升高而升高,LVEF随心功能分级的升高而降低,差异均有统计学意义(P<0.05)。经Pearson相关分析显示,CHF患者血清Chemerin水平与MWS、LVMI、LVEDD呈正相关(r=0.396、0.462、0.513,P均<0.05),与LVEF呈负相关(r=-0.429,P<0.05)。结论 CHF患者中血清Chemerin水平异常升高,且与心室重构、心功能密切相关,可考虑将其作为临床诊断CHF的生物学指标。
Objective To discuss the changes and clinical significance of level of serum Chemokine in patients with chronic heart failure(CHF). Methods CHF patients(n=93) were chosen into study group from Beijing Anzhen Hospital affiliated to Capital University of Medical Sciences from Sept. 2013 to Dec. 2017. The study group was divided, according to heart function grading of NYHA, into grade Ⅱ group(n=28), grade Ⅲ group(n=31) and grade Ⅳ group(n=34), and other patients(n=30) with non-CHF arrhythmia were chosen into control group at the same time. The level of serum Chemerin, heart functional indexes including left ventricular ejection fraction(LVEF) and left ventricular end-diastolic inner diameter(LVEDd), and ventricular remodeling indexes including mean wall stress(MWS) and left ventricular mass index(LVMI) were detected and compared in different groups. The correlation among level of serum Chemerin, heart functional indexes and ventricular remodeling indexes was analyzed by using Pearson correlation coefficients. Results The level of serum Chemerin, and LVEDd, MWS and LVMI were significantly higher, and LVEF was significantly lower in study group than those in control group(P<0.05). The comparisons in the level of serum Chemerin, heart functional indexes and ventricular remodeling indexes had statistical significance in grade Ⅱ group, grade Ⅲ group and grade Ⅳgroup(P<0.05). The level of serum Chemerin, and LVEDd, MWS and LVMI increased with the increase of heart function grading, and LVEF decreased with the increase of heart function grading(P<0.05). The results of Pearson correlation analysis showed that the level of serum Chemerin was positively correlation to MWS, LVMI and LVEDD(r=0.396,r=0.462, r=0.513, all P<0.05), and negatively correlated to LVEF(r=-0.429, P<0.05). Conclusion The level of serum Chemerin increases abnormally in CHF patients, and it is closely correlated to ventricular remodeling and heart function.It can be taken as a biological index for diagnosing CHF in clinic.
Objective To discuss the changes and clinical significance of level of serum Chemokine in patients with chronic heart failure(CHF). Methods CHF patients(n=93) were chosen into study group from Beijing Anzhen Hospital affiliated to Capital University of Medical Sciences from Sept. 2013 to Dec. 2017. The study group was divided, according to heart function grading of NYHA, into grade Ⅱ group(n=28), grade Ⅲ group(n=31) and grade Ⅳ group(n=34), and other patients(n=30) with non-CHF arrhythmia were chosen into control group at the same time. The level of serum Chemerin, heart functional indexes including left ventricular ejection fraction(LVEF) and left ventricular end-diastolic inner diameter(LVEDd), and ventricular remodeling indexes including mean wall stress(MWS) and left ventricular mass index(LVMI) were detected and compared in different groups. The correlation among level of serum Chemerin, heart functional indexes and ventricular remodeling indexes was analyzed by using Pearson correlation coefficients. Results The level of serum Chemerin, and LVEDd, MWS and LVMI were significantly higher, and LVEF was significantly lower in study group than those in control group(P<0.05). The comparisons in the level of serum Chemerin, heart functional indexes and ventricular remodeling indexes had statistical significance in grade Ⅱ group, grade Ⅲ group and grade Ⅳgroup(P<0.05). The level of serum Chemerin, and LVEDd, MWS and LVMI increased with the increase of heart function grading, and LVEF decreased with the increase of heart function grading(P<0.05). The results of Pearson correlation analysis showed that the level of serum Chemerin was positively correlation to MWS, LVMI and LVEDD(r=0.396,r=0.462, r=0.513, all P<0.05), and negatively correlated to LVEF(r=-0.429, P<0.05). Conclusion The level of serum Chemerin increases abnormally in CHF patients, and it is closely correlated to ventricular remodeling and heart function.It can be taken as a biological index for diagnosing CHF in clinic.
引文
[1]王利冉,程广清.益气活血方与运动康复训练结合西医常规疗法治疗慢性心力衰竭临床研究[J].国际中医中药杂志,2018,40(2):111.
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[3]于彤彤,刘双双,王菁菁,等.慢性心力衰竭患者在临床特点及危险因素方面的性别差异[J].山东医药,2015,55(12):49-51.
[4]Lindberg S,Jensen JS,Bjerre M,et al.Cardio-adipose tissue cross-talk:relationship between adiponectin,plasma pro brain natriuretic peptide and incident heart failure[J].Eur J Heart Fail,2014,16(6):633-8.
[5]郑辉,葛焕琦.网膜素对心血管系统的影响[J].国际内分泌代谢杂志,2016,36(4):261-5.
[6]Li JJ,Yin HK,Guan DX,et al.Chemerin suppresses hepatocellular carcinoma metastasis through CMKLR1-PTEN-Akt axis[J].Br JCancer,2018,118(10):1337-48.
[7]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[J].中华心血管病杂志,2007,35(12):1076-95.
[8]单春方,陈艳,马依彤,等.新疆不同民族老年人群心力衰竭患病率调查[J].中华流行病学杂志,2014,35(9):1007-10.
[9]梁逸强,潘朝锌,何新兵,等.心室重构发病机制的研究进展[J].河北医药,2013,35(24):3781-4.
[10]刘静,刘恒亮,白树鸣,等.缺血性心脏病合并心力衰竭患者冠脉病变特点[J].实用医学杂志,2017,33(20):3424-8.
[11]庞祥中,李俭强,李为民,等.脂肪细胞因子chemerin与心血管疾病关系的研究进展[J].国际心血管病杂志,2016,43(4):213-6.
[12]王蒙琴,金树琦,张柱,等.血清趋化素水平与慢性心力衰竭患者左室重构的相关性研究[J].中国现代医学杂志,2018,28(14):76-9.
[13]骆瑜,熊玮,董少红,等.ApoE-/-小鼠动脉粥样硬化进程中趋化素表达的变化及意义[J].解剖学杂志,2017,40(6):678-81.
[14]Menzel J,di Giuseppe R,Biemann R,et al.Association between chemerin,omentin-1 and risk of heart failure in the population-based EPIC-Potsdam study[J].Sci Rep,2017,7(1):14171.
[15]梅艳,郗爱旗,廖宝霞,等.低氧环境下慢性充血性心力衰竭患者脂肪因子水平变化对心室构型的影响[J].第三军医大学学报,2017,39(23):2299-302.
[16]Kammerer A,Staab H,Herberg M,et al.Increased circulating chemerin in patients with advanced carotid stenosis[J].BMC Cardiovasc Disord,2018,18(1):65.
[17]熊玮,董少红,张键,等.趋化素通过上调磷酸化JNK促进小鼠血管平滑肌细胞的增殖[J].中国病理生理杂志,2015,31(12):2282-6.
[2]黄峻.慢性心力衰竭的现状和中药治疗前景[J].中西医结合心脑血管病杂志,2015,13(1):1-2.
[3]于彤彤,刘双双,王菁菁,等.慢性心力衰竭患者在临床特点及危险因素方面的性别差异[J].山东医药,2015,55(12):49-51.
[4]Lindberg S,Jensen JS,Bjerre M,et al.Cardio-adipose tissue cross-talk:relationship between adiponectin,plasma pro brain natriuretic peptide and incident heart failure[J].Eur J Heart Fail,2014,16(6):633-8.
[5]郑辉,葛焕琦.网膜素对心血管系统的影响[J].国际内分泌代谢杂志,2016,36(4):261-5.
[6]Li JJ,Yin HK,Guan DX,et al.Chemerin suppresses hepatocellular carcinoma metastasis through CMKLR1-PTEN-Akt axis[J].Br JCancer,2018,118(10):1337-48.
[7]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[J].中华心血管病杂志,2007,35(12):1076-95.
[8]单春方,陈艳,马依彤,等.新疆不同民族老年人群心力衰竭患病率调查[J].中华流行病学杂志,2014,35(9):1007-10.
[9]梁逸强,潘朝锌,何新兵,等.心室重构发病机制的研究进展[J].河北医药,2013,35(24):3781-4.
[10]刘静,刘恒亮,白树鸣,等.缺血性心脏病合并心力衰竭患者冠脉病变特点[J].实用医学杂志,2017,33(20):3424-8.
[11]庞祥中,李俭强,李为民,等.脂肪细胞因子chemerin与心血管疾病关系的研究进展[J].国际心血管病杂志,2016,43(4):213-6.
[12]王蒙琴,金树琦,张柱,等.血清趋化素水平与慢性心力衰竭患者左室重构的相关性研究[J].中国现代医学杂志,2018,28(14):76-9.
[13]骆瑜,熊玮,董少红,等.ApoE-/-小鼠动脉粥样硬化进程中趋化素表达的变化及意义[J].解剖学杂志,2017,40(6):678-81.
[14]Menzel J,di Giuseppe R,Biemann R,et al.Association between chemerin,omentin-1 and risk of heart failure in the population-based EPIC-Potsdam study[J].Sci Rep,2017,7(1):14171.
[15]梅艳,郗爱旗,廖宝霞,等.低氧环境下慢性充血性心力衰竭患者脂肪因子水平变化对心室构型的影响[J].第三军医大学学报,2017,39(23):2299-302.
[16]Kammerer A,Staab H,Herberg M,et al.Increased circulating chemerin in patients with advanced carotid stenosis[J].BMC Cardiovasc Disord,2018,18(1):65.
[17]熊玮,董少红,张键,等.趋化素通过上调磷酸化JNK促进小鼠血管平滑肌细胞的增殖[J].中国病理生理杂志,2015,31(12):2282-6.