摘要
目的硫化氢(hydrogensulfide,H2S)在机体各系统的生理调节过程中均起重要作用,H2S对老年缺血性心力衰竭(ischemic heart failure,IHF)患者的生理调节作用机制并不十分明确。本研究通过对IHF患者进行硝普钠干预治疗,探讨血浆H2S水平变化与IHF病情变化关系以及与N末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-ProBNP)变化的相关性。方法选取辽河油田总医院2016-09-01-2019-05-31收治的80例老年IHF患者为研究对象,根据年龄、性别组间匹配原则,在80例病例中选择25例为常规治疗组,25例为硝普钠治疗组。NT-ProBNP水平检测采用定量酶联免疫吸附法,血浆H2S水平检测采用去蛋白法。比较观察各心功能水平组血浆H2S和NT-ProBNP水平,以及治疗前后心脏功能、结构和血浆H2S水平变化情况。结果心功能Ⅱ级患者H2S水平为(41.27±3.87)μmol/L,高于心功能Ⅲ级患者的(30.21±4.56)μmol/L及Ⅳ级患者的(19.59±3.47)μmol/L,差异有统计学意义,F=184.570,P<0.001;心功能Ⅱ级患者NT-ProBNP水平[NT-ProBNP自然对数,即Ln(NT-ProBNP)]为(6.85±0.40),低于心功能Ⅲ级患者的(8.37±0.47)及Ⅳ级患者的(9.36±0.46),差异有统计学意义,F=207.966,P<0.001。硝普钠治疗组治疗后H2S水平为(52.5±3.3)μmol/L,高于常规治疗组的(41.6±7.9)μmol/L,差异有统计学意义,t=6.365,P<0.001;LVEF水平为(49.6±13.6)%,高于常规治疗组的(45.6±11.5)%,但差异无统计学意义,t=1.123,P=0.267。老年IHF患者血浆H2S水平与lnNT-ProBNP呈负相关,r=-0.824,P=0.032。结论老年IHF患者血浆H2S水平明显降低,且随心功能水平提高呈升高趋势。常规治疗联合使用硝普钠可显著提高射血分数、升高老年IHF患者血浆H2S水平。
OBJECTIVE Hydrogen sulfide(H2 S)plays an important role in the physiological regulation of various systems in the body.H2 S is not very clear on the mechanism of physiological regulation in elderly patients with ischemic heart failure(IHF).In this study,by interfering with nitroprusside treatment in IHF patients,the relationship between changes in plasma H2 S levels and IHF disease status and changes in Nterminal probrainerty peptide precursors(NT-ProBNP)were explored.METHODS In this study,80 elderly patients with IHF admitted to Liaohe Oilfield General Hospital from September 1,2016 to May 31,2019 were selected as research objects.According to the matching principle of age and gender,25 of 80 cases were selected as routine treatment group and 25 as sodium nitroprusside treatment group.The level of NT-proBNP was measured by quantitative enzyme-linked immunosorbent assay(ELISA),and the level of plasma H2 S was measured by deproteinization.The experiment was divided into two stages.The first stage was to compare the differences of the levels of H2 S and NT proBNP between the observation group and the healthy people.In the second stage,50 patients in the observation group were randomly selected as the research object.50 patients in the observation group were randomly divided into the conventional treatment group(n=25)and sodium nitroprusside group.The changes of heart function,structure and plasma H2 S level before and after treatment were compared.RESULTS The leveⅠof H2 S in patients with levelⅡcardiac function is(41.27±3.87)μmol/L,which is higher than that in levelⅢpatients(30.21±4.56)μmol/L and levelⅣpatients(19.59±3.47)μmol/L,the difference Statistically significant,F=84.570,P<0.001.NT-ProBNP level[NT-ProBNP natural logarithm,that is,Ln(NT-ProBNP)]in patients with cardiac functionⅡis(6.85±0.40),lower than cardiac functionⅢ(8.37±0.47)and GradeⅣpatients(9.36±0.46),the difference was statistically significant,F=207.966,P<0.001.The H2 S level in the sodium nitroprusside treatment group was(52.5±3.3)μmol/L,which was higher than that in the conventional treatment group(41.6±7.9)μmol/L,the difference was statistically significant,t=6.365,P<0.001.LVEF level was(49.6±13.6)%,which was higher than that of the conventional treatment group(45.6±11.5)%,but the difference was not statistically significant,t=1.123,P=0.267.The plasma H2 S level in elderly IHF patients was negatively correlated with lnNT-ProBNP,r=-0.824,P=0.032.CONCLUSIONS Compared with those with physical examination,plasma H2 S levels in elderly patients with IHF were significantly lower,and plasma H2 S levels also increased with the increase of cardiac function.Conventional treatment combined with sodium nitroprusside treatment significantly increased ejection fraction and elevated plasma H2 S levels in elderly patients with IHF.
作者
许园园
陈玉凤
XU Yuan-yuan;CHEN Yu-feng(Department of Clinical Laboratory,Liaohe Oilfield General Hospital,Panjin124000,P.R.China;Department of Laboratory,Dalian Municipal Center for Disease Control and Prevention,Dalian116021,P.R.China)
出处
《社区医学杂志》
2020年第7期513-516,共4页
Journal Of Community Medicine
