李菊香 廖春耀 江华 夏珍 俞建华 洪葵 苏海 吴清华 程晓曙

DOI：10.3760/cma.j.issn.1671-0282.2015.03.009

基金項目：科技部863课题（2012AA02A516）; 赣鄱英才555工程

作者单位：330006 南昌，南昌大学第二附属医院心内科

通信作者：李菊香，Email：ljx912@126.com

【摘要】目的 探讨扩张型心肌病患者血同型半胱酸（HCY）水平的变化及临床意义。方法 连续收集116例扩张型心肌病患者，男92例，女24例，年龄18～70岁，（47.4±12.7）岁。所有患者常规行心电图、胸片和超声心动图检查，以及甲状腺功能、生化检测，必要时行冠状动脉造影，排除高血压、冠心病、风湿性心脏病、先天性心脏病、糖尿病、动脉硬化等，明确诊断为扩张型心肌病。所有患者入院第二天抽血检测血同型半胱氨酸和脑钠肽（BNP）水平，并与30例年龄、性别相匹配的阵发性室上性心动过速（非发作期、排除结构性心脏病）患者进行比较。行回顾性分析。结果 扩张型心肌病组血同型半胱氨酸水平显著高于对照组（P<0.01），且与心功能级别呈正比，与血浆BNP水平呈直线正相关关系（r=0.667，P<0.01），与左室舒张未径和收缩末径显著相关（r=0.498，P<0.01;r=0.462，P<0.01）;而与射血分数呈负相关关系（r=-0.55，P<0.01）。结论 血HCY的水平与心衰严重程度密切相关，与B型脑钠肽呈正相关，从而为慢性心力衰竭程度的评价提供新的指标。

【关键词】同型半胱酸;心肌病;心功能

Change of the level of plasma homocysteine in patients with dilated cardiomyopathy

Li Juxiang，Liao Chunyao， Jiang Hua，Xia Zhen， Yu Jianhua，Hong Kui，Su Hai，Wu Qinghua，Cheng Xiaoshu.Department of Cardiovascular Medicine， The Second Affiliated Hospital to Nanchang University， Nanchang 330006，China

Corresponding author： Li Juxiang， Email： ljx912@126.com

【Abstract】Objective To explore change and clinical significance of the level of plasma homocysteine （HCY） in patients with dilated cardiomyopathy （DCM） .Methods All subjects consisted of 116 consecutively hospitalized patients with DCM， including 92 male and 24 female， aged from 18 to 70 years old with average age （47.4±12.7） years， and another 30 age and sex matched patients with paroxysmal supraventricular tachycardia （non-attack period， without organic heart disease） as controls. Electrocardiogram， chest X-ray and echocardiography were routinely performed， as well as thyroid function and biochemical tests， and coronary arteriography when necessary. The diagnosis of DCM was confirmed by exclusion of hypertension， coronary heart disease， rheumatic heart disease， congenital heart disease， diabetes mellitus， arteriosclerosis， etc. Blood samples were obtained to determine plasma HCY and B-type natriuretic peptide （BNP） levels at the next morning after admission of the patients with DCM or paroxysmal supraventricular tachycardia. A retrospective analysis was carried out.Results Plasma HCY level of patients in DCM group was significantly higher than that in control group （P<0.01）. Correlation analysis showed that plasma HCY level was positively correlated with heart function and plasma BNP level （r=0.667， P<0.01）， and was significantly correlated with left ventricular diastolic diameter and end-systolic diameter （r=0.498， P<0.01; r=0.462， P<0.01）， and was negatively correlated with ejection fraction （r=-0.55，P<0.01）. Conclusion Plasma HCY level was associated with the severity of heart failure and was positively related to plasma BNP level， providing a novel indicator for the evaluation of chronic heart failure.

【Key words】Homocysteine; Cardiomyopathy; Heart function

研究表明，同型半胱氨酸水平升高（HHCY） 是心血管疾病的独立危险因素。血浆同型半胱氨酸水平与高血压，脑中风，周围血管疾病，以及冠状动脉疾病密切相关[1-2]。新近研究表明心力衰竭（CHF）患者血浆HCY的水平升高，可增加CHF的发病率并使心衰加重[3-4]。本文排除血管硬化等其他因素的影响，单纯探讨扩张型心肌病CHF患者血浆HCY水平的变化及临床意义。

1 资料与方法

1.1 一般资料

2010年5月至2013年12月在南昌大学第二附属医院住院诊断为扩张型心肌病患者116例，年龄18～70岁，（47.4±12.7）岁，男92例，女24例。心功能Ⅱ级42例，Ⅲ级52例，Ⅳ级22例。心功能分级参照《纽约心脏病学心功能分级》标准，扩张型心肌病的诊断标准参照（2007年中华心血管病杂志）《心肌病诊断与治疗建议》。……