CAJ | 학술논문

目的：探讨射血分数正常的心力衰竭（ HFpEF）患者血清胆红素水平与舒张功能不全的相关性。方法2014年1—12月诊治HFpEF患者80例为HFpEF组，根据超声检查结果分为3个亚组：轻度亚组13例、中度亚组44例、重度亚组23例，另选取健康体检者30例为健康对照组。通过心脏超声测量左房内径、左室舒张末期内径、左室短轴缩短率、左室射血分数、左室舒张末期容积、E峰、A峰、舒张早期二尖瓣环运动速度，并计算E／Ea值。综合统计分析胆红素水平与心脏超声各项结果的关系。结果中度亚组和重度亚组HFpEF患者总胆红素（ TB）和直接胆红素（DB）均明显高于健康对照组（TB：t 中度＝1？．732， P ＝0．045；t 重度＝2．032， P ＝0．025。 DB：t 中度＝2．732， P ＝0．007；t 重度＝2．036， P ＝0．026），HFpEF患者组内比较可见，重度亚组HFpEF患者血清TB和DB明显低于轻度亚组（TB：t ＝1．715， P ＝0．047；DB：t ＝2．032， P ＝0．024）。 HFpEF组患者Ea峰明显低于健康对照组（ t ＝0．010， P ＝0．017），而E／Ea高于健康对照组（ t ＝0．022， P ＝0．032）。重度亚组患者Ea峰和E／Ea均明显差于轻度亚组（Ea峰：t ＝2．079， P ＝0．023；E／Ea：t ＝2．411， P ＝0．011）。 TB及DB水平与E／Ea呈负相关（ r ＝－0．401， P ＝0．040；r ＝－0．434， P ＝0．030）。通过多元逐步回归分析表明，血清TB水平可作为自变量能分别进入E峰（ P ＝0．003）和Ea峰（ P ＝0．003）为因变量的线性回归模型方程。结论胆红素水平与心室舒张功能密切相关，可能是影响HFpEF发生机制中的重要危险因素。
목적：탐토사혈분수정상적심력쇠갈（ HFpEF）환자혈청담홍소수평여서장공능불전적상관성。방법2014년1—12월진치HFpEF환자80례위HFpEF조，근거초성검사결과분위3개아조：경도아조13례、중도아조44례、중도아조23례，령선취건강체검자30례위건강대조조。통과심장초성측량좌방내경、좌실서장말기내경、좌실단축축단솔、좌실사혈분수、좌실서장말기용적、E봉、A봉、서장조기이첨판배운동속도，병계산E／Ea치。종합통계분석담홍소수평여심장초성각항결과적관계。결과중도아조화중도아조HFpEF환자총담홍소（ TB）화직접담홍소（DB）균명현고우건강대조조（TB：t 중도＝1？．732， P ＝0．045；t 중도＝2．032， P ＝0．025。 DB：t 중도＝2．732， P ＝0．007；t 중도＝2．036， P ＝0．026），HFpEF환자조내비교가견，중도아조HFpEF환자혈청TB화DB명현저우경도아조（TB：t ＝1．715， P ＝0．047；DB：t ＝2．032， P ＝0．024）。 HFpEF조환자Ea봉명현저우건강대조조（ t ＝0．010， P ＝0．017），이E／Ea고우건강대조조（ t ＝0．022， P ＝0．032）。중도아조환자Ea봉화E／Ea균명현차우경도아조（Ea봉：t ＝2．079， P ＝0．023；E／Ea：t ＝2．411， P ＝0．011）。 TB급DB수평여E／Ea정부상관（ r ＝－0．401， P ＝0．040；r ＝－0．434， P ＝0．030）。통과다원축보회귀분석표명，혈청TB수평가작위자변량능분별진입E봉（ P ＝0．003）화Ea봉（ P ＝0．003）위인변량적선성회귀모형방정。결론담홍소수평여심실서장공능밀절상관，가능시영향HFpEF발생궤제중적중요위험인소。
Objective To investigate the correlation between serum bilirubin level and diastolic dysfunction in pa -tients with heart failure (HFpEF) with normal ejection fraction.Methods From 2014 January to 2014 December, 80 patients with HFpEF were enrolled .According to the results of ultrasound examination , patients were divided into 3 subgroups:mild subgroup with 13 cases, moderate sub group with 44 cases, severe sub group with 23 cases, 30 cases of healthy physical ex-amination were selected as healthy control group .Left atrial diameter , left ventricular end diastolic diameter , left ventricular ejection fraction, left ventricular end diastolic volume , E peak, A peak, early diastolic mitral annular velocity were measured by echocardiography , and E/Ea values were calculated .The relationship between bilirubin level and cardiac ultrasound and the results of echocardiography were analyzed .Results Moderate sub group and severe subgroups ’ total bilirubin ( TB) and direct bilirubin (DB) were significantly higher than those of healthy control group (TB in moderate subgroups:t =1.732, P =0.045;TB in severe sub group:t =2.032, P =0.025.DB in moderate subgroups:t =2.732, P =0.007;TB in severe sub group:t =2.036, P =0.026), comparison within HFpEF group, severe HFpEF subgroup’s serum TB and dB was sig-nificantly lower than that of the mild sub group (TB:t =1.715, P =0.047;DB:t =2.032, P =0.024).HFpEF group’s EA peak was significantly lower than that in healthy control group ( t =0.010, P =0.017) and E /EA was higher than that of healthy control group ( t =0.022, P =0.032).Severe subgroup’s EA peak and E /EA were significantly lower than mild sub group (EA peak:t =2.079, P =0.023;E /EA:t =2.411, P =0.011).A negative correlation between TB and DB levels and E/Ea were existed ( r =-0.401, P =0.040;r =-0.434, P =0.030).By multivariate stepwise regression analysis showed that serum level of TB can be as an independent variable into e peak ( P =0.003 ) and EA peak ( P =0.003) respectively as the dependent variable for linear regression equation .Conclusion Bilirubin level is closely related to ventricular diastolic function , which may be an important risk factor in the pathogenesis of HFpEF .