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潘逸茹, 喻红之, 龚立琪, 薛惠君. 老年心力衰竭患者血清脂联素的测定[J].检验医学, 2015,25(9): 712-714
PAN Yiru, YU Hongzhi, GONG Liqi, XUE Huijun. The determination of serum adiponectin in elderly patients with heart failure[J]. Labratory Medicine, 2015,25(9): 712-714  
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《检验医学》编辑部
老年心力衰竭患者血清脂联素的测定
潘逸茹, 喻红之, 龚立琪, 薛惠君
复旦大学附属华东医院检验科,上海 200040

作者简介:潘逸茹,女,1965年生,学士,主任技师,主要从事临床生化检验工作。

摘要
目的 探讨脂联素与心力衰竭的关系。方法 采用酶联免疫吸附试验(ELISA)及电化学发光法分别测定54例左心室射血指数(LVEF)<40%的心力衰竭患者和18名正常对照者血清脂联素、氨基末端B型钠尿肽原(NT-proBNP),并作统计分析。结果 心力衰竭患者的体重指数(BMI)[(22.17±2.48) kg/m2]与对照组[(23.32±2.03) kg/m2]差异无统计学意义( P>0.05);LVEF(30.92%±8.75 %)显著低于对照组(70.14%±9.33 %, P<0.01);血清脂联素[(23.62±5.43) mg/L]及NT-proBNP[(592.00±153.00) pg/mL]显著高于对照组[(10.81±2.64) mg/L,(21.00±3.49) pg/mL, P<0.01]。心力衰竭组脂联素与BMI、LVEF呈负相关( r=-0.41、-0.32, P<0.05);对照组脂联素与BMI呈负相关( r=-0.387, P<0.05);心力衰竭组脂联素与NT-proBNP呈正相关( r=0.49, P<0.01),对照组则无相关性( r=0.11, P>0.05)。调整BMI、年龄后,脂联素与LVEF的负相关依然存在,与NT-proBNP的正相关依然存在。结论 血清脂联素与心力衰竭发病密切,通过更大规模的临床病例研究将为脂联素检测成为临床心力衰竭诊断的重要指标提供强有力的证据。
关键词: 脂联素; 氨基末端B型钠尿肽原; 心力衰竭
中图分类号:R446.1 文献标志码:A 文章编号:1673-8640(2010)09-0712-03
The determination of serum adiponectin in elderly patients with heart failure
PAN Yiru, YU Hongzhi, GONG Liqi, XUE Huijun
Department of Clinical Laboratory,Huadong Hospital, Fudan University, Shanghai 200040, China
Abstract
Objective To investigate the relationship between adiponectin and heart failure.Methods Serum adiponectin levels and amino-terminal pro-B type natriuretic peptide (NT-proBNP) levels in 54 heart failure patients with left ventricular ejection fraction (LVEF) <40% and 18 healthy controls were measured by enzyme-linked immunosorbent assay (ELISA) and electrochemilum inescence assay. The results were analyzed statistically.Results The body mass index (BMI) in heart failure group [(22.17±2.48) kg/m2] was lower than that in healthy controls [(23.32±2.03) kg/m2, P>0.05]. The LVEF in heart failure group (30.92%±8.75%) was significantly lower than that in healthy controls (70.14%±9.33%, P<0.01). The levels of serum adiponectin in heart failure group [(23.62±5.43) mg/L] were significantly higher than those in healthy controls [(10.81±2.64) mg/L, P<0.01], and the NT-proBNP in heart failure group [(592.00±153.00) pg/mL] was significantly higher than that in healthy controls [(21.00±3.49) pg/mL, P<0.01]. Adiponectin was negatively correlated with BMI and LVEF in heart failure group, and the correlation coefficients ( r) were -0.41 and -0.32 respectively ( P<0.05). In the healthy controls, adiponectin was negatively correlated with BMI ( r=-0.387, P<0.05). There was a positive association between adiponectin and NT-proBNP in the heart failure group ( r=0.49, P<0.01), and there was no correlation between adiponectin and NT-proBNP in healthy controls ( r=0.11, P>0.05). These associations remained significantly after adjustment for age and BMI.Conclusions There is a significant association between serum adiponectin and the incidence of heart failure. It will provide more evidences for using adiponectin in the diagnosis of heart failure through more and more researches on clinical cases.
Keyword: Adiponectin; Amino-terminal pro-B type natriuretic peptide; Heart failure

Laontaris等[1]研究发现血浆脂联素与心力衰竭患者的死亡率相关 , 血浆脂联素水平与心力衰竭患者的运动功能受损有关, 认为脂联素是心力衰竭严重程度的标志物之一。我们拟通过对确诊男性心力衰竭患者血浆脂联素及其他指标的测定, 评价脂联素与心功能之间的关系。

材料和方法
一、材料

1. 研究对象 54例无症状心力衰竭患者来自复旦大学附属华东医院近1年的就诊患者, 均为男性, 年龄65~88岁。诊断参照相关文献[2], 平均左心室射血指数(LVEF)为30.92%± 8.75%, 排除肾功能异常。正常对照组为复旦大学附属华东医院健康体检者18名, 均为男性, 年龄55~92岁, 排除心、肝、肾功能等疾病。

2. 仪器 罗氏ECL-2010电化学发光自动免疫仪, Wellscan MK3酶标仪。

3. 试剂 氨基末端B型钠尿肽原(NT-proBNP)测定试剂盒来源于罗氏公司, 脂联素测定试剂盒为日本Otsuka公司产品。

二、方法

NT-proBNP测定采用电化学发光法, 脂联素测定采用酶联免疫吸附试验(ELISA)。体重指数(BMI)=体重(kg)/身高(m)2。

三、统计学方法

采用SPSS 10.0软件进行分析, 资料以 x̅± s表示, 两组之间比较采用t检验, 指标间相关关系采用多重线性回归分析。

结 果

一、心力衰竭患者的NT-proBNP及脂联素水平均高于正常对照组(P< 0.01), LVEF低于正常对照组(P< 0.01), 而BMI与正常对照组无差异。见表1。

表1 心力衰竭组及正常对照组血浆脂联素、NT-proBNP测定结果

二、脂联素与其他指标相关性分析

心力衰竭组脂联素与BMI和LVEF呈负相关, 与NT-proBNP呈正相关, 见表2。通过多重线性回归分析发现, 调整BMI、年龄后, 脂联素与LVEF的负相关依然存在, 与NT-proBNP的正相关依然存在, 见表3。

表2 脂联素与BMI、LVEF和NT-proBNP的相关性分析(校正前)
表3 脂联素与LVEF和NT-ProBNP的相关性分析(校正后)
讨 论

脂肪组织不仅是机体储存能量的场所, 还是功能活跃的内分泌器官, 分泌多种活性因子, 如瘦素、脂联素、内脂素等脂肪细胞因子。目前的研究认为, 脂肪细胞因子参与多种肥胖相关性疾病的发生, 如胰岛素抵抗2型糖尿病、代谢综合征、动脉硬化等。脂联素是脂肪组织分泌的含量丰富的蛋白质, 具有心脏保护功能, 缺血性心脏病患者外周血脂联素水平低下, 且低水平脂联素与缺血性心脏病患者心血管事件发生的危险性增加有关[3]。另有研究表明充血性心力衰竭患者的血浆脂联素水平升高且高脂联素水平与该部分人群的较差预后显著相关[4]。心脏作为内分泌器官, 衰竭的心脏具有分泌多个激素的功能, 培养的心肌细胞具有产生脂联素的能力, 与脂肪组织相比, 其产生的脂联素水平较低[5]。心力衰竭患者血浆脂联素升高可能与心包来源和心肌来源的脂联素有关。不同病因的心力衰竭患者心室的心肌中有大量脂肪组织存在, 心外膜脂肪积聚的量与心肌的量相平行。心包脂肪组织表达脂联素[6], 因此心力衰竭患者血液中的脂联素可能来自心脏脂肪组织, 其分泌的脂联素进入了循环系统。另外, 最近的研究表明在脂肪分解抑制存在的条件下, 心房肽直接刺激培养的脂肪细胞分泌脂联素[7]。因此, 心力衰竭患者心房肽和B型钠尿肽(BNP)水平的升高, 可能刺激心外膜和脂肪组织分泌脂联素, 引起患者循环系统脂联素水平升高。至于升高的脂联素是否具有对心力衰竭进行性补偿的保护作用仍需进一步研究。本研究发现心力衰竭患者血浆脂联素水平高于正常对照者, 且与LVEF呈负相关、与BNP呈正相关。因此, 脂联素可作为心力衰竭诊断和预后的辅助指标。

The authors have declared that no competing interests exist.

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