CAJ | 학술논문

目的检测克山病与扩张型心肌病(DCM)患者全血中5种微量元素的水平,探讨5种微量元素在克山病发病中的作用.方法在山东、四川、内蒙古3个克山病病区省选取104例克山病患者,在山东大学齐鲁医院、济南市中心医院、第一人民医院选择就诊的30例DCM患者,并以91例克山病病区健康人和39例济南市健康人作为病区和非病区健康对照组.按知情同意原则,采集受检者血液,应用荧光法和原子吸收法测定全血中硒(Se)、铜(Cu)、锌(Zn)、铬(Cr)、锰(Mn)的水平.结果克山病组Se、Zn、Cr水平[(36.0±4.9)μg/L、(22.73±4.62)mg/L、(0.56±0.17)mg/L]与非病区健康对照组[(56.4±6.8)μg/L、(25.35±4.44)mg/L、(0.71±0.17)mg/L]比较明显降低(P均＜0.05),Cu[(0.95±0.24) mg/L]明显升高[(0.73±0.13) mg/L,P＜0.05]；克山病组Se、Cr水平与病区健康对照组[(54.5±5.4)μg/L、(0.87±0.02)mg/L]比较明显降低(P均＜0.05),Cu明显升高[(0.66±0.02)mg/L,P＜0.05]；克山病组Cu、Zn水平与DCM组[(1.21±0.23)mg/L、(27.09±7.10)mg/L]比较明显降低(P均＜0.01).DCM组Se、Cr水平[(39.6±3.5)μg/L、(0.58±0.14)mg/L]与非病区健康对照组比较明显降低(P均＜ 0.01),Cu[(1.21±0.23) mg/L]明显升高(P＜0.01)；病区健康对照组Se水平与非病区健康对照组比较明显降低(P＜0.01),Cu明显升高(P＜0.01).5种元素水平在按不同心功能分组后,克山病组Se、Zn和Cr水平随心功能级别升高呈逐渐降低趋势,Cu水平呈逐渐升高趋势.结论克山病患者Se、Cr、Cu、Zn代谢失衡,Se水平仍低于非病区健康居民；克山病患者与DCM患者全血Se、Cr、Cu、Mn水平改变相一致.
목적 검측극산병여확장형심기병(DCM)환자전혈중5충미량원소적수평,탐토5충미량원소재극산병발병중적작용.방법 재산동、사천、내몽고3개극산병병구성선취104례극산병환자,재산동대학제로의원、제남시중심의원、제일인민의원선택취진적30례DCM환자,병이91례극산병병구건강인화39례제남시건강인작위병구화비병구건강대조조.안지정동의원칙,채집수검자혈액,응용형광법화원자흡수법측정전혈중서(Se)、동(Cu)、자(Zn)、락(Cr)、맹(Mn)적수평.결과 극산병조Se、Zn、Cr수평[(36.0±4.9)μg/L、(22.73±4.62)mg/L、(0.56±0.17)mg/L]여비병구건강대조조[(56.4±6.8)μg/L、(25.35±4.44)mg/L、(0.71±0.17)mg/L]비교명현강저(P균＜0.05),Cu[(0.95±0.24) mg/L]명현승고[(0.73±0.13) mg/L,P＜0.05]；극산병조Se、Cr수평여병구건강대조조[(54.5±5.4)μg/L、(0.87±0.02)mg/L]비교명현강저(P균＜0.05),Cu명현승고[(0.66±0.02)mg/L,P＜0.05]；극산병조Cu、Zn수평여DCM조[(1.21±0.23)mg/L、(27.09±7.10)mg/L]비교명현강저(P균＜0.01).DCM조Se、Cr수평[(39.6±3.5)μg/L、(0.58±0.14)mg/L]여비병구건강대조조비교명현강저(P균＜ 0.01),Cu[(1.21±0.23) mg/L]명현승고(P＜0.01)；병구건강대조조Se수평여비병구건강대조조비교명현강저(P＜0.01),Cu명현승고(P＜0.01).5충원소수평재안불동심공능분조후,극산병조Se、Zn화Cr수평수심공능급별승고정축점강저추세,Cu수평정축점승고추세.결론 극산병환자Se、Cr、Cu、Zn대사실형,Se수평잉저우비병구건강거민；극산병환자여DCM환자전혈Se、Cr、Cu、Mn수평개변상일치.
Objective To detect the levels of five trace elements in whole blood of patients with Keshan disease(KSD) and dilated cardiomyopathy(DCM) and explore their role in the pathogenesis of KSD.Methods One hundred and four patients with chronic KSD were selected from Keshan diseased areas in Shandong,Sichuan and Inner Mongolia.Thirty patients with DCM were selected from Qilu Hospital of Shandong University,Jinan Central Hospital,The First People's Hospital.Ninety-one healthy people from KSD endemic areas and 39 healthy people from Jinan were selected as endemic healthy controls and non-endemic healthy controls,respectively.Blood samples were collected to determinate the level of selenium (Se),copper (Cu),zinc (Zn),chromium (Cr) and manganese (Mn) with fluorescence method and atomic absorption spectrometry,according to the principle of informed consent.Results The level of Se,Zn and Cr of KSD group[(36.0 + 4.9)μg/L,(22.73 + 4.62)mg/L,(0.56 + 0.17)mg/L] was significantly lower than that of non-endemic healthy controls [(56.4 ± 6.8)lμg/L,(25.35 ± 4.44)mg/L,(0.71 ± 0.17)mg/L,all P ＜ 0.05],but the level of Cu of KSD group[(0.95 ± 0.24)mg/L] was significantly higher than that of non-endemic healthy controls[(0.73 ± 0.13) mg/L,all P ＜ 0.05].The level of Se and Cr of KSD was significantly lower than that of endemic healthy controls[(54.5 ± 5.4)μg/L,(0.87 ± 0.02)mg/L,P ＜ 0.05],and Cu was significantly higher than that of endemic healthy controls[(0.66 ± 0.02)mg/L,P ＜ 0.05].The level of Cu and Zn of KSD was significantly lower than that of DCM [(1.21 ± 0.23)mg/L,(27.09 ± 7.10)mg/L,all P ＜ 0.01].The level of Se and Cr of DCM group[(39.6 ± 3.5)μg/L,(0.58 ± 0.14)mg/L] was significantly lower than that of non-endemic healthy controls(all P ＜ 0.01),but Cu[(1.21 + 0.23)mg/L] was significantly increased (P ＜ 0.01).Compared with non-endemic healthy controls,the level of Se of endemic healthy control group was significantly decreased (P ＜ 0.01),while Cu was significantly increased (P ＜ 0.01).Se,Zn and Cr level of KSD decreased gradually following elevated heart function level,but the level of Cu gradually increased.Conclusions The metabolism of Se,Cr,Cu and Zn is unbalanced in KSD patients,whose Se level is still lower than that of people in non-endemic areas.The change of Se,Cr,Cu and Mn level between KSD and DCM is consistent.