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目的:探讨慢性心力衰竭(CHF)患者不同血尿酸(UA)水平和左室重构程度的关系。方法:565例CHF患者,按NYHA心功能分级分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级,分别为236、138、132、59例;按照AHA/ACC的CHF分期法分为B、C、D期,分别为236、270、59例;健康体检者105例作为对照组。所有入选者入院后急诊或常规检查UA、肝肾功能、电解质等项目;超声心动图测定心脏左室舒张末期内径(LVEDd)、室间隔厚度(IVSd)、左室后壁厚度(LVPWd),计算左室质量(LVM)和左室质量指数(LVMI)。结果:CHF患者UA水平较对照组明显增加(P<0.05),排除利尿剂的影响后仍随心功能分级和分期增高而增加;CHF组中UA增高者LVM、LVMI、LVEDd、LVPWd及左室肥厚发生率均显著高于UA正常者(P<0.01);直线相关分析显示LVM、LVMI与UA呈明显的正相关,分别为r=0.406,P<0.01;r=0.388,P<0.01。结论:UA异常是CHF患者代谢障碍的早期信号,是左室重构的促进因素。
Objective: To investigate the relationship between different uric acid (UA) levels and left ventricular remodeling in patients with chronic heart failure (CHF). Methods: 565 CHF patients were divided into three groups according to NYHA functional class Ⅰ, Ⅱ, Ⅲ and Ⅳ, respectively, which were 236, 138, 132 and 59. According to the CHF staging of AHA / ACC, they were divided into B, C, , Respectively, 236,270,59 cases; 105 healthy subjects as a control group. All candidates were admitted to hospital emergency or routine examination of UA, liver and kidney function, electrolytes and other items; echocardiography measured left ventricular end-diastolic diameter (LVEDd), interventricular septum thickness (IVSd), left ventricular posterior wall thickness (LVPWd) Left ventricular mass (LVM) and left ventricular mass index (LVMI). Results: The UA level in CHF patients was significantly higher than that in control group (P <0.05), and the levels of UA increased after cardiac function grading and staging in patients with CHF. The levels of LVM, LVMI, LVEDd, LVPWd and left ventricular hypertrophy (P <0.01). The linear correlation analysis showed that there was a significant positive correlation between LVM, LVMI and UA, r = 0.406, P <0.01; r = 0.388, P <0.01. CONCLUSIONS: UA abnormalities are early signs of metabolic disorders in CHF patients and contribute to left ventricular remodeling.