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目的探讨慢性心力衰竭(CHF)患者血清甲状旁腺激素(PTH)与肾素-血管紧张素-醛固酮系统(RAAS)活性的相关性及意义。方法选择东风总医院住院的CHF患者71例为心力衰竭组,根据纽约心脏病协会(NYHA)制定的心功能分级标准:Ⅱ级患者21例,Ⅲ级患者26例,Ⅳ级患者24例。同时选择我院同期健康体检者50例,作为健康对照组。测定血清PTH、血清醛固酮(ALD)、血浆血管紧张素Ⅱ(Ang-Ⅱ)、血浆肾素(PRA)及血浆脑钠肽(BNP)浓度并分析其相关性。结果 CHF患者PTH、ALD、Ang-Ⅱ、PRA及BNP浓度均明显高于对照组,差异有统计学意义(P<0.01)。心功能Ⅳ级、Ⅲ级、Ⅱ级的CHF患者PTH、ALD、Ang-Ⅱ、PRA及BNP浓度比较,差异有统计学意义(P<0.01);其中心功能Ⅳ级、Ⅲ级患者PTH、ALD、Ang-Ⅱ、PRA及BNP浓度均高于心功能Ⅱ级患者,心功能Ⅳ级患者PTH、ALD、Ang-Ⅱ、PRA及BNP浓度均高于心功能Ⅲ级患者,差异有统计学意义(P<0.01或P<0.05);且各指标浓度随心功能分级的增加而逐渐增高。Pearson相关分析:CHF患者PTH水平与RAAS活性及心功能分级的严重程度呈正相关。结论 CHF患者PTH水平与RAAS活性及心功能分级严重程度呈正相关,且其浓度随着心功能分级的增加而逐渐增高,两者相互作用,共同参与慢性心力衰竭的致病机制。
Objective To investigate the correlation between serum parathyroid hormone (PTH) and renin-angiotensin-aldosterone system (RAAS) activity in patients with chronic heart failure (CHF). Methods Totally 71 CHF patients admitted to Dongfeng General Hospital were heart failure patients. According to the New York Heart Association (NYHA) classification of heart function, 21 patients were grade Ⅱ, 26 patients were grade Ⅲ and 24 patients were grade Ⅳ. At the same time select 50 cases of our hospital during the same period healthy physical examination, as a healthy control group. Serum levels of PTH, serum aldosterone (ALD), plasma angiotensin Ⅱ (Ang Ⅱ), plasma renin (PRA) and plasma brain natriuretic peptide (BNP) were measured and their correlations were analyzed. Results The levels of PTH, ALD, Ang-Ⅱ, PRA and BNP in CHF patients were significantly higher than those in control group (P <0.01). The levels of PTH, ALD, Ang-Ⅱ, PRA and BNP in patients with CHF of grade Ⅳ, grade Ⅲ, and grade Ⅱ were significantly different (P <0.01) , Ang Ⅱ, PRA and BNP levels were higher than those in patients with cardiac function grade Ⅱ. The levels of PTH, ALD, Ang-Ⅱ, PRA and BNP in patients with grade Ⅳ heart function were higher than those in patients with grade Ⅲ cardiac function, the difference was statistically significant P <0.01 or P <0.05). The concentration of each index increased gradually with the increase of cardiac function. Pearson correlation analysis: PTH levels in CHF patients were positively correlated with the severity of RAAS activity and cardiac function classification. Conclusions There is a positive correlation between the level of PTH and the severity of RAAS activity and heart function in CHF patients. The concentration of PTH is gradually increased with the increase of heart function classification. The interaction between them may be involved in the pathogenesis of chronic heart failure.