射血分数保留的心力衰竭患者左心功能变化的临床特点及与血清炎症因子水平的关系

射血分数保留的心力衰竭患者左心功能变化的临床特点及与血清炎症因子水平的关系摘要:目的分析探讨射血分数保留的心力衰竭（heart failure with preserved left ventricular ejection fracti on，HFPEF）患者左心功能相关指标变化、血清炎症因子水平变化，以及其临床意义。

方法步骤如下，从2015年1月到2018年10月在本院就诊的心力衰竭病人中随即抽取186人为研究对象,即研究组,下文简称为HF-PEF组,该实验的对照组是该时间段内在医院就诊的心功能正常的病人,对照组下文简称为NHF组,详细记录研究组和对照组的临床资料、白介素-6（interleukin- 6，IL- 6）、肿瘤坏死因子-α（Tumor Necr osis Factor，TNF-α）)以及C反应蛋白(C-reactionprotein，CRP）等血清炎症因子指标、左房前后径（L eft atrial anteroposterior diameter，LA）、左心室射血分数（left ventricular ejection fraction，LV EF）以及左心室舒张末期内径（left ventricular end-diastolic dimension，LVEDD）心脏超声指标，并比较两组不同心功能级别的心力衰竭患者血清炎症因子、心脏超声指标的变化,得出内在的关键性。

结果研究组病人的LA、血清IL-6、TNF-α及CRP水平都要比实验组的病人高,但是LVEF水平要比NHF组低些,存在巨大的差异(P均<0.05)。

在HF-PEF组中,血清IL-6、LA、CPR和TNF-α水平与心功能级别呈正比，即上述指标水平会随着心功能级别的增大而提高，差异都有统计学意义；而在对照组中，LVEDD差异则没有统计学意义，并且在研究中组中，心功能IV级病人的LVEF和LVEDD与心功能II级、III级作比较，,差异具有统计学意义。

通过研究分析Spearman的相关性,结果显示血清炎症因子会随着心功能级别、LA、LVEDD的增大而增加,但是血清炎症因子会随着LVEF的增大而下降。

结论血清炎症因子、LA、LVEDD、LA、以及LVEF 都可以用于判断病人是否患有HF-PEF,联合应用对HF-PEF的早期诊断及治疗有重要意义。

关键词:射血分数保留的心力衰竭;左心功能指标;血清炎症因子水平Clinical features of left ventricular function changes in heart failure patients with ejection fraction retent ion and their relationship with serum inflammatory cytokinesAbstract: 【Objective】To analyze ejection fraction retained heart failure in patients with left heart function changes related indicators, serum levels of inflammatory factors, and its clinical significance.【Methods】From January 2015 to October 2018 in our hospital clinic in patients with heart failure and extract the 186 study, the research team, hereinafter referred to as HF - PEF group and the control of the experiment is the period of internal hospital patients with normal cardiac function, the control group hereinafter referred to as NHF group, a detailed record of thegroup and the control group clinical data, interleukin - 6, Tumor Necrosis Factor alpha and c-reactive protein index, serum inflammatory factors such as diameter after the Left front, Left atrial anteroposterior diameter, Left ventricular ejection fraction and Left ventricular end-diastolic diameter, Left ventricular end - diastolic dimension, and compared the changes of serum inflammatory factors and cardiac ultrasound indicators between the two groups of heart failure patients with different levels of cardiac function, so as to obtain the internal key. 【Results】LA, serum il-6, TNF-, and CRP levels were higher in the study group than in the experimental group, but LVEF levels were lower than in the NHF group, with significant differences (all P <0.05). In HF-PEF group, serum il-6, LA, CPR and TNF- levels were positively proportional to cardiac function level, that is, the above indexes would increase with the increase of cardiac function level, and the difference was statistically significant. However, in the control group, the difference in LVEDD was not statistically significant, and in the study group, LVEF and LVEDD of patients with grade IV heart function were compared with those with grade II and III heart function, and the difference was statistically significant. Spearman correlation analysis showed that serum inflammatory factors increased with the increase of cardiac function level, LA, and LVEDD, while serum inflammatory factors decreased with the increase of LVEF. 【Conclusion】Serum inflammatory cytokines, LA, LVEDD, LA, and LVEF can all be used to determine whether patients have HF-PEF. Combined application is of great significance for the early diagnosis and treatment of HF-PEF.Keywords: heart failure with preserved left ventricular ejection fraction; Left ventricular function index; Serum levels of inflammatory cytokines射血分数保留的心力衰竭(HF-PEF)属于一类复杂的临床综合征,多发生在老年女性群体中,临床表现为心力衰竭,但LVEF大于等50%,与左室舒张功能不全关系密切,但是目前的研究表明HFpEF还与左心室收缩功能障碍、肺血管顺应性下降、左心房功能等其它因素相关[1]。

最近研究表明在HFpEF的发病机制中左心房的结构及功能改变占有举足轻重的地位。

现如今,研究指出[2-3],炎症因子在HF的发病过程中有着很重要的作用,对此,有关专家认为炎症因子变化水平可以很好的反映出心力衰竭发生的潜在机制及其将来的发生发展。

本实验的研究对象是HF-PEF,通过对多种心功能分组的左心结构、功能指标及血清炎症因子水平变化的观察,找出其内在联系。

1资料与方法1.1 一般资料，本实验的研究组是从2015年1月至2018年10月在安徽中医药大学附属滁州中西医结合医院心内科就诊的射血分数保留的心力衰竭病人中，随机抽取186人，均符合2016年欧洲心脏病协会心力衰竭指南诊断标准[4]，男女比例为5：6，平均年龄在72.64±6.42这个区间内，体质量指数(kg/m2)25.89±3.34,收缩压(mmHg)143.14±22.86,舒张压(mmHg)82.03±15.42,TC(mmol/L)4.04±1.24,TG(mmol/L)1.7 6±0.43,LDL-c(mmol/L)2.43±0.64,吸烟105例,稳定型心绞痛124例,糖尿病82例,心律失常106例,根据NYHA心功能分级标准，分为若干组,Ⅱ级、Ⅲ级、Ⅳ级分别有63人、61人、62人。

另外选取同时期住院的186例心功能正常的病人，作为NHF组即对照组，男女比例为23：32，平均年龄在74.12±5.24之间，体质量指数在26.35±2.92之间,收缩压(mmHg)148.24±20.24,舒张压(mmHg)86.24±9.12,TC(mmol/L)4.1 2±1.07,TG(mmol/L)1.82±0.72,LDL-c(mmol/L)2.56±0.52,吸烟110例,稳定型心绞痛83例,糖尿病62例,心律失常82例。