扩张型心肌病心衰患者血清尿酸浓度的动态变化及其临床意义

1、    扩张型心肌病心衰患者血清尿酸浓度的动态 变化及其临床意义        摘要目的：探讨扩张型心肌病心衰患者血清尿酸浓度的变化规律及其临床意义。方法：比较扩张型心肌病(IDC，46例)不同心功能状态下的尿酸浓度；比较22例心衰控制前后的尿酸浓度；比较左室内经65mm(26例)和<65mm(16例)患者的尿酸浓度、入院时未用利尿剂及正在服用利尿剂患者的尿酸浓度、BUN>7.5(18例)和7.5mmol/L(28例)患者的尿酸浓度。结果：IDC心功能、

2、级的尿酸分别为303±34，403±95和595±190mmol/L，级心功能者尿酸浓度明显高于级者(P<0.01)；心衰控制前后尿酸浓度分别为609±218和414±147mmol/L，心衰控制后尿酸浓度明显降低(P<0.01)；左室内径65mm者尿酸明显高于<65mm者(P<0.01)；入院时服与未服利尿剂者尿酸无明显差异(P>0.05)；BUN>7.5与7.5mmol/L者尿酸浓度无明显差异(P>0.05)。结论：扩张型心肌病心衰患者尿酸浓度增高，增高程度与心衰严重程度有关，而独立于服用利尿剂及肾

3、功能不全；可以认为血清尿酸浓度是反映心衰患者病情严重程度的一个指标。关键词尿酸心功能不全扩张型心肌病中分类号R542.2文献标识码A THE DYNAMIC CHANGES OF SERUM URIC ACID IN PATIENTS WITH IDIOPATHICDILATED CARDIOMYOPATHY AND ITS CILNICAL SIGNIFICANCETai Xiao-xia(No.2 people's Hospital,Suzhou 215002,China)AbstractObjective：To assess the rules and clinical sign

4、ificance of increased serum uric acid in patients with idiopathic dilated cardiomyopathy(IDC).Methods：The studied population consisted of 46 patients with idiopathic dilated cardiomyopathy(IDC).New York Heart Association(NYHA) functional class -.Serum uric acid was assessed.we devided the IDC patien

5、ts into different groups according to:the severity of heart failure,left ventricular internal diameter(LVID)(65mm),diuretic therapy and blood urea nitrogen(BUN)(7.5mmol/L).Results：The concentration of serum uric acid in IDC patients NYHA functional class 、 was 303±34,403±95 and 595±19

6、0mmol/L respectively.The concentration of serum uric acid increased significantly in patients with cardiac function class as compared to those class (p<0.01).Serum uric acid was 609±218/414±147mmil/L before/after stabilixation of heart failure(p<0.01).It was much higher in patients w

7、hose LVID65mm as compared to those LVID<65mm(572±182 vs.425±112,P<0.01).There was no differencs between the patients who received diurtics or not (533±21 vs.501±16,p>0.05).BUN also did not influence serum uric acid.Conclusions： The increased serum uric acid was associate

8、d with deterioration of heart failure and independent of diurtics therapy or renal function insufficiency.It was a predictor of the severity of heart failure.KeywordsUricacidHeart failureldiopathicdilated cardiomyopthy。业已证实，慢性心衰时，循环血液中反映炎症的细胞因子如肿瘤坏死因子(TNF)、白细胞介素6(IL6)、细胞粘附分子等增高，且和心衰严重程度相关。但慢性心衰患者血清尿

9、酸浓度变化有关报道少见。本文探讨扩张型心肌病心衰时血清尿酸浓度变化的意义，并探讨尿酸升高是否和心衰患者使用利尿剂或伴有肾功能损害有关。1材料和方法2结果见附表。附表不同情况下心衰患者血清尿酸水平比较n尿酸浓度P值心功能级级级心衰控制前控制后左室内径65mm<65mm服利尿剂未服利尿剂BUN>7.57.5215292222261627191828303±34403±95595±190609±218414±147572±183425±112533±21501±16533±199483&#

10、177;177<0.01<0.01<0.01>0.05>0.05     3讨论 本文结果显示，扩张型心肌病心衰患者血清尿酸水平增加，左室内径越大，心衰越重，其浓度升高的程度越大，排除利尿剂和肾功能影响后，此种关系仍存在，提示心衰患者血清尿酸升高是独立于利尿剂和肾功能损害的，这和文献1一致。Leyva等2研究表明，慢性心衰患者最大氧摄取量降低，且和NYHA心功能分级有关。心衰越重，降低程度越大，表明存在氧代谢受损。尿酸是嘌呤代谢的最终产物，心衰患者存在低氧血症，缺氧、无氧代谢增加，糖原酵解增加，ATP生成减少，ATP的耗竭促

11、使腺嘌呤降解为肌苷、黄嘌呤、次黄嘌呤和尿酸，这可能是心衰患者尿酸升高的原因之一。高尿酸血症也见于全身紫绀型心脏病和慢性阻塞性肺气肿，这是高尿酸血症与缺氧有关的另一证据3。文献1，4，5报道慢性心衰患者血清尿酸和慢性炎症标记物(如肿瘤坏死因子，白介素-6，细胞粘附分子等)升高。尿酸增加反映黄嘌呤氧化酶活性增加，黄嘌呤氧化酶活性增加引起诱发炎症的自由基生成增多，因而认为，尿酸升高是炎症反应、细胞损伤的一个重要标记物。扩张型心肌病病因不清楚，但一部分扩张型心肌病由慢性炎症发展而来，这是否也是血尿酸升高的一个原因，有待研究。邰晓霞(苏州市第二人民医院心内科江苏 苏州215002)参 考 文 献1，Le

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