血清瘦素和脂联素水平与非缺血性扩张型心肌病患者预后的关系研究

摘要

目的 分析血清瘦素和脂联素水平与非缺血性扩张型心肌病(NIDCM)患者预后的关系.方法 选取2012—2015年在西安市第五医院确诊的NIDCM患者68例作为试验组,其中纽约心脏病协会(NYHA)分级Ⅰ级15例,Ⅱ级24例,Ⅲ级17例,Ⅳ级12例;体质指数(BMI)正常22例,超重18例,肥胖28例.另选取同期体检健康者40例作为对照组.采用电话或入院就诊等方式对所有患者进行随访,随访截至患者死亡或2016-12-31.比较对照组与试验组受试者、不同BMI患者血脂指标、肌酐(Cr)水平及血清瘦素、脂联素水平,并比较不同NYHA分级患者血清瘦素、脂联素水平;血清瘦素、脂联素水平与NIDCM患者BMI的相关性分析采用Pearson相关性分析;绘制Kaplan-Meier生存曲线以评价不同血清瘦素、脂联素水平患者生存状况.结果 对照组与试验组受试者总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、Cr水平比较,差异无统计学意义(P>0.05);试验组患者血清瘦素、脂联素水平高于对照组(P<0.05).不同BMI患者TC、TG、HDL-C、LDL-C、Cr水平比较,差异无统计学意义(P>0.05);超重和肥胖患者血清瘦素和脂联素水平高于BMI正常患者,肥胖患者血清瘦素和脂联素水平高于超重患者(P<0.05).NYHA分级Ⅱ级、Ⅲ级及Ⅳ级患者血清瘦素和脂联素水平高于NYHA分级Ⅰ级患者,NYHA分级Ⅲ级及Ⅳ级患者血清瘦素和脂联素水平高于NYHA分级Ⅱ级患者, NYHA分级Ⅳ级患者血清瘦素和脂联素水平高于NYHA分级Ⅲ级患者(P<0.05).Pearson相关性分析结果显示,血清瘦素、脂联素水平与NIDCM患者BMI呈正相关(r值分别为0.844、0.789,P<0.05).Kaplan-Meier生存曲线显示,血清瘦素水平≤5.74 μg/L患者生存状况优于血清瘦素水平>5.74 μg/L患者(P<0.05);血清脂联素水平≤12.45 mg/L患者生存状况优于血清脂联素水平>12.45 mg/L患者(P<0.05).结论 NIDCM患者血清瘦素和脂联素水平明显升高,且其水平变化与患者心力衰竭严重程度及预后有关.%Objective To investigate the relationship of serum level of leptin,of adiponectin and prognosis in patients with non-ischemic dilated cardiomyopathy(NIDCM).Methods A total of 68 patients with NIDCM were selected as test group in the Fifth Hospital of Xi'an from 2012 to 2015,including 15 cases with Ⅰ -NYHA grade,24 cases withⅡ-NYHA grade,17 cases with Ⅲ-NYHA grade,12 cases with Ⅳ-NYHA grade;22 cases with normal BMI,18 cases with overweight,28 cases with obesity;meanwhile a total of 40 healthy people admitted to this hospital for physical examination were selected as control group.Patients in test group were followed up till death or 2016-12-31 by telephone or seeing a doctor. Blood lipids index,Cr,serum levels of leptin and adiponectin were compared between control group and test group,in patients with different BMI,meanwhile serum levels of leptin and adiponectin were compared in patients with different NYHA grades;correlations of serum levels of leptin and adiponectin with BMI in patients with NIDCM were analyzed by Pearson correlation analysis;Kaplan-Meier survivorship curve was drawn to evaluate the survival status in patients with different serum levels of leptin and adiponectin.Results No statistically significant differences of TC,TG,HDL-C,LDL-C or Cr was found between control group and test group(P>0.05),while serum levels of leptin and adiponectin in test group were statistically significantly higher than those in control group(P<0.05).No statistically significant differences of TC,TG,HDL-C,LDL-C or Cr was found in patients with different BMI(P>0.05);serum levels of leptin and adiponectin in patients with overweight or obesity were statistically significantly higher than those in patients with normal BMI,meanwhile serum levels of leptin and adiponectin in patients with obesity were statistically significantly higher than those in patients with overweight(P<0.05).Serum levels of leptin and adiponectin in patients with Ⅱ-,Ⅲ- or Ⅳ-NYHA grade were statistically significantly higher than those in patients withⅠ-NYHA grade,serum levels of leptin and adiponectin in patients with Ⅲ- or Ⅳ-NYHA grade were statistically significantly higher than those in patients with Ⅱ-NYHA grade,serum levels of leptin and adiponectin in patients with Ⅳ-NYHA grade were statistically significantly higher than those in patients withⅢ-NYHA grade(P<0.05).Pearson correlation analysis results showed that,serum levels of leptin(r=0.844)and adiponectin(r=0.789)was positively correlated with BMI in patients with NIDCM,respectively(P<0.05).Kaplan-Meier survivorship curve showed that,survival status in patients with serum leptin level equal or less than 5.74 μg/L was statistically significantly better than that in patients with serum leptin level over 5.74 μg/L,and survival status in patients with serum adiponectin level equal or less than 12.45 mg/L was statistically significantly better than that in patients with serum adiponectin level over 12.45 mg/L(P<0.05).Conclusion Serum levels of leptin and adiponectin are significantly elevated in patients with NIDCM,and the change is closely correlated with heart failure severity and the prognosis.