黄嘌呤氧化酶在缺血性心肌病HFrEF患者血清中的水平及相关因素的临床研究

发布时间：2018-11-07 09:34

【摘要】：背景:慢性心力衰竭(Chronic heart failure,CHF)是严重影响人类健康的重要疾病之一,是众多其他类型心血管疾病的终末期表现,其发病率高,预后差,5年存活率与恶性肿瘤相仿。随着人口老龄化及心血管疾病危险因素的上升,由缺血性心肌病引起的心衰的发病率仍将继续增长,其中射血分数减低的慢性心力衰竭(HFr EF)的患者生活质量明显受影响。心力衰竭是由于任何原因促使心肌损伤,引起心肌结构和功能的改变,最终导致心室泵血功能降低。心力衰竭发生发展的基本机制是心室重塑,是心血管疾病晚期共有的终末期损害。近年来,在心衰的发生发展过程中黄嘌呤氧化酶(xanthine oxidase,XO)依赖的氧化应激与心衰的关系得到研究者的关注。在心衰发生发展过程中,XO呈正性调节,随着心衰的加重,XO活性增强且蛋白负荷增加。血尿酸(uric acid,UA)水平可反映XO的活性。心脏脂肪酸结合蛋白(heart fatty acid binding protein,H-FABP)浓度与心功能级别呈正相关,随着心功能的恶化,H-FABP逐渐升高。课题组在临床工作中发现慢性心力衰竭患者血尿酸水平升高,且与心衰的严重程度相关。而血尿酸(UA)水平可反映XO的活性,心衰患者血清中金属蛋白酶-2、-9(MMP-2、MMP-9)水平的增高与其心肌组织中XO活性的增强具有一定的相关性。因此,本课题拟通过对HFr WF慢性心衰患者进行XO、H-FABP、MMP-2、MMP-9及心脏结构与功能检测,为缺血性心肌病HFr EF诊断提供新思路和理论依据。目的:探讨射血分数(EF)减低的心力衰竭患者血清中黄嘌呤氧化酶(XO)水平及其与心脏脂肪酸结合蛋白(H-FABP),金属蛋白酶-2,-9(MMP-2,MMP-9)、肌钙蛋白T(CTn T)的相关性。方法:选取慢性心力衰竭患者及健康体检的正常人80例为研究对象,确诊为射血分数减低的心力衰竭患者40例(心力衰竭组),健康体检正常者40例(对照组),分别测量两组患者的身高、体质量、血压,留取空腹静脉血,采用酶联免疫吸附实验分别检测两组血清中XO、H-FABP、MMP-2、MMP-9、CTn T水平。结果:与对照组比较,心力衰竭组患者血清中XO水平显著高于对照组(P0.01)。心力衰竭组患者血清XO水平与心脏脂肪酸结合蛋白(H-FABP),金属蛋白酶-2,-9(MMP-2,MMP-9)呈正相关(r=0.787,0.838和0.864,P0.01)。结论:射血分数减低的心力衰竭(HFr EF)患者血清中黄嘌呤氧化酶(XO)水平均显著增高,射血分数减低的心力衰竭(HFr EF)患者血清黄嘌呤氧化酶(XO)水平心脏脂肪酸结合蛋白(H-FABP),金属蛋白酶-2,-9相关(MMP-2,MMP-9)。
[Abstract]:Background: chronic heart failure (Chronic heart failure,CHF) is one of the most important diseases affecting human health. It is the end-stage manifestation of many other cardiovascular diseases with high incidence and poor prognosis. The 5-year survival rate is similar to that of malignant tumors. With the aging of the population and the increase of cardiovascular risk factors, the incidence of heart failure caused by ischemic cardiomyopathy will continue to increase, and the quality of life of patients with chronic heart failure (HFr EF) with decreased ejection fraction will be significantly affected. Heart failure is caused by any cause of myocardial injury, resulting in changes in myocardial structure and function, and ultimately lead to the reduction of ventricular pump function. The basic mechanism for the development of heart failure is ventricular remodeling, which is a common end-stage lesion in the late stage of cardiovascular disease. In recent years, the relationship between xanthine oxidase (xanthine oxidase,XO)-dependent oxidative stress and heart failure has been concerned by researchers. In the process of occurrence and development of heart failure, XO was positively regulated. With the aggravation of heart failure, the activity of XO increased and the protein load increased. The level of serum uric acid (uric acid,UA) can reflect the activity of XO. Cardiac fatty acid binding protein (heart fatty acid binding protein,H-FABP) concentration was positively correlated with cardiac function grade, and H-FABP gradually increased with the deterioration of cardiac function. In our clinical work, we found that the level of uric acid in patients with chronic heart failure increased, and was related to the severity of heart failure. The level of serum uric acid (UA) can reflect the activity of XO. The increase of serum metalloproteinase-2 (MMP-2,MMP-9) level is correlated with the increase of XO activity in myocardial tissue of patients with heart failure. Therefore, in order to provide a new idea and theoretical basis for the diagnosis of ischemic cardiomyopathy (HFr EF), the XO,H-FABP,MMP-2,MMP-9 and cardiac structure and function of HFr WF patients with chronic heart failure were examined. Objective: to investigate the level of xanthine oxidase (XO) and its association with heart fatty acid binding protein (H-FABP), metalloproteinase-2 (MMP-2,MMP-9) in patients with heart failure with decreased ejection fraction (EF). Correlation of troponin T (CTn T). Methods: a total of 80 patients with chronic heart failure (CHF) and 80 healthy controls were selected as subjects. 40 patients with CHF diagnosed as low ejection fraction (CHF group) and 40 normal subjects (control group) were enrolled in this study. Height, body mass, blood pressure and fasting venous blood were measured, and serum XO,H-FABP,MMP-2,MMP-9,CTn T levels were measured by Elisa. Results: compared with control group, serum XO level in heart failure group was significantly higher than that in control group (P0.01). The level of serum XO was positively correlated with heart fatty acid binding protein (H-FABP) and metalloproteinase-2 (MMP-2,MMP-9) in heart failure group (r = 0.787N 0.838, r = 0.864n, P 0.01). Conclusion: the serum (XO) levels of xanthine oxidase in patients with (HFr EF) with decreased ejection fraction were significantly increased. Serum (XO) levels of xanthine oxidase in patients with (HFr EF) with decreased ejection fraction; heart fatty acid binding protein (H-FABP) and metalloproteinase-2 (MMP-2,MMP-9) -9 correlation.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.6

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