CAJ | 학술논문

目的：探讨内源性大麻素水平与慢性心力衰竭（CHF）患者心功能的相关性。方法纳入CHF患者（CHF组）260例，有共同心血管疾病但从未发生心力衰竭的患者（p-CHF组）130例及健康对照者（健康对照组）130名。心功能评价依据NYHA心功能分级以及M型超声测量患者LVEF、心排出量、左心室舒张期末径（LVEDD）及左心室收缩期末径（LVSDD）；使用高效液相色谱仪检测血浆花生四烯酸乙醇胺（AEA）及2-花生四烯酸甘油（2-AG）水平。结果 CHF组AEA、2-AG、脑利钠肽水平明显高于健康对照组及p-CHF组（P＜0.01）。单因素方差分析显示血浆AEA、2-AG水平在NHYA I级患者中最低，在NYHA IV级患者中最高，两两比较差异有统计学意义（P＜0.01）。秩相关分析显示，血浆AEA及2-AG水平均与NYHA心功能分级呈高度正相关（AEA：rs ＝0.84；P＜0.01；2-AG：rs ＝0.95；P＜0.01）。血浆AEA及2-AG水平均与血浆脑利钠肽浓度呈正相关（rAEA ＝0.83，P＜0.01；r2-AG＝0.97；P＜0.01）。血浆AEA水平与LVEF、心排出量、LVEDD及LVSDD均呈相关关系，其中与LVEF的相关性最好，相关系数为-0.63（P＜0.01）；血浆2-AG亦与上述各指标呈现良好相关性，其中与LVEF相关性最好，相关系数为-0.73（P＜0.01）。结论心力衰竭患者血浆AEA及2-AG水平均有所升高，其中以2-AG浓度升高明显；心力衰竭患者血浆AEA及2-AG浓度与患者心功能呈正相关；内源性大麻素系统（ECS）有望成为心力衰竭药物干预新靶点，可能具有广阔的应用前景。
목적：탐토내원성대마소수평여만성심력쇠갈（CHF）환자심공능적상관성。방법납입CHF환자（CHF조）260례，유공동심혈관질병단종미발생심력쇠갈적환자（p-CHF조）130례급건강대조자（건강대조조）130명。심공능평개의거NYHA심공능분급이급M형초성측량환자LVEF、심배출량、좌심실서장기말경（LVEDD）급좌심실수축기말경（LVSDD）；사용고효액상색보의검측혈장화생사희산을순알（AEA）급2-화생사희산감유（2-AG）수평。결과 CHF조AEA、2-AG、뇌리납태수평명현고우건강대조조급p-CHF조（P＜0.01）。단인소방차분석현시혈장AEA、2-AG수평재NHYA I급환자중최저，재NYHA IV급환자중최고，량량비교차이유통계학의의（P＜0.01）。질상관분석현시，혈장AEA급2-AG수평균여NYHA심공능분급정고도정상관（AEA：rs ＝0.84；P＜0.01；2-AG：rs ＝0.95；P＜0.01）。혈장AEA급2-AG수평균여혈장뇌리납태농도정정상관（rAEA ＝0.83，P＜0.01；r2-AG＝0.97；P＜0.01）。혈장AEA수평여LVEF、심배출량、LVEDD급LVSDD균정상관관계，기중여LVEF적상관성최호，상관계수위-0.63（P＜0.01）；혈장2-AG역여상술각지표정현량호상관성，기중여LVEF상관성최호，상관계수위-0.73（P＜0.01）。결론심력쇠갈환자혈장AEA급2-AG수평균유소승고，기중이2-AG농도승고명현；심력쇠갈환자혈장AEA급2-AG농도여환자심공능정정상관；내원성대마소계통（ECS）유망성위심력쇠갈약물간예신파점，가능구유엄활적응용전경。
Objective To investigate the relationship between endocannabinoids level and cardiac function of patients with chronic heart failure (CHF). Methods Two hundred and sixty CHF patients (CHF group),cardiovascular disease without heart failure patients (p-CHF group,n=1 30 )and healthy patientss (Control group,n=1 30)were enrolled.New York Heart Association (NYHA)functional class was used to e-valuate cardiac function. Left ventricular ejection fraction (LVEF),heart output,left ventricular internal di-mension diastole,left ventricular internal dimension systole were tested by M echocardiography. Plasma Anan-damine (AEA)and 2-arachidonoylglycerol (2-AG)levels were measured by high-performance liquid chroma-tography. Results In group CHF,AEA,2-AG,brain natriuretic peptide levels were significantly higher than those in the healthy control group and p-CHF group (P<0.01 ). Single factor analysis of variance showed that plasma AEA,2-AG level in NHYA class I patients were the lowest,and were the highest in the NYHA class IV patients.There were significant difference between every two groups of patients with different grade of heart function.The rank correlation analysis showed that the plasma AEA and 2-AG levels were positively asso-ciated with NYHA cardiac functional grading (AEA:rs =0.84;P<0.01;2-AG:rs =0.95;P<0.01 ).Plasma AEA and 2-AG levels were positively associated with plasma brain natriuretic peptide (rAEA =0.83,P<0.01;r2-AG=0.97;P<0.01 ). Plasma levels of AEA and LVEF,cardiac output,LVEDD and LVSDD wererelated to,LVEF has the best correlation,The correlation coefficient is -0.63 (P<0.01 );Plasma 2-AG and the above indexes showed a good correlation,The best correlation with LVEF,The correlation coeffi-cient is -0.73 (P<0.01 ). Conclusion Plasma AEA and 2-AG levels in heart failure patients both in-creased,especially 2-AG. Plasma AEA and 2-AG were positively correlated with cardiac function in patients with heart failure. Endocannabinoid system (ECS)is expected to become a new target for drug intervention in heart failure,which may be popular in clinical application.