目的 探讨老年高血压合并心力衰竭患者神经内分泌激素水平及其与心力衰竭严重程度分级的相关性.方法 选择2010年8月～2012年2月广东省廉江市人民医院治疗的老年高血压合并心力衰竭患者57例为观察组,选择同期单纯高血压患者57例为对照组.比较两组患者血清血管紧张素Ⅱ(AngⅡ)、内皮素-1(ET-1)、皮质醇(Cor)、β-内啡肽(β-EP)、脑钠肽(BNP)、促肾上腺皮质激素(ACTH)及去甲肾上腺素(NE)水平；观察组中NY-HA分级Ⅱ、Ⅲ及Ⅳ级者的上述指标进行比较,对其相关性进行分析研究.结果 ①观察组血清AngⅡ[(101.34±9.45)ng/L]、ET-1 [(100.26±9.56)ng/L]、Cor[(272.86± 16.32)μg/L]、β-EP[(96.33±8.21)ng/L]、BNP[(341.51±16.27)ng/L]、ACTH[(30.14±4.52) ng/L]及NE[(1.15±0.11) μμg/L]水平均明显高于对照组[(68.36±6.36)ng/L、(70.34±7.02)ng/L、(202.17±12.25)μg/L、(56.29±5.48)ng/L、(132.18±11.07)ng/L、(19.45±3.31)ng/L、(0.37±0.07)μg/L],差异均有统计学意义(P＜0.05).②观察组中NYHA分级Ⅳ级者血清AngⅡ[(123.57±10.48)ng/L]、ET-1[(118.84±11.23)ng/L]、Cor[(307.63± 17.26) μg/L]、β-EP[(110.37±10.12)ng/L]、BNP[(338.26±19.25) ng/L]、ACTH[(43.62±5.17) ng/L]、NE[(1.98±0.18)μg/L]水平高于Ⅱ级[(75.26±7.46)ng/L、(81.72±8.14)ng/L、(229.43±13.54)μg/L、(74.92±6.93)ng/L、(181.35±13.37)ng/L、(22.33±4.22)ng/L、(0.86±0.10)μg/L]及Ⅲ级[(100.42±9.29)ng/L、(99.28±9.34)ng/L、(268.84±15.92)μg/L、(93.18±7.95)ng/L、(296.42±15.77)ng/L、(32.54±4.65)ng/L、(1.23±0.14)μg/L]患者,Ⅲ级患者AngⅡ、ET-1、Cor、β-EP、BNP、ACTH、NE水平高于Ⅱ级患者,差异均有统计学意义(P＜0.05).③血清AngⅡ、ET-1、Cor、β-EP、BNP、ACTH及NE水平均与心功能分级密切相关(P＜0.05).结论 老年高血压合并心力衰竭患者神经内分泌激素水平与心力衰竭严重程度分级存在密切相关性,对其检测有助于了解患者的心功能状态.%Objective To study the correlation on the expression of neuroendocrine hormone levels and the severity degree of heart failure in patients with hypertension combined with cardiac failure.Methods 57 elderly patients with hypertension and heart failure who were treated and diagnosed in the People's Hospital of Lianjiang City from August 2010 to February 2012 were selected as observation group,and 57 patients with only hypertension at the same time were selected as the control group.The serum angiopoietin Ⅱ (Ang Ⅱ),endothelin-1 (ET-1),cortisol (Cor),[β-endorphin (β-EP),brain natriuretic peptide (BNP),adreno-cortico-tropic-hormone (ACTH) and Noradrenaline (NE) of two groups were compared,these indexes in observation group with NYHA Ⅱ,Ⅲ and Ⅳ grade were compared too,then the correlation were analyzed.Results ①The serum Ang Ⅱ,ET-1,Cor,β-EP,BNP,ACTH and NE in observation group [(101.34±9.45)ng/L,(100.26±9.56) ng/L,(272.86±16.32)μg/L,(96.33±8.21)ng/L,(341.51±16.27) ng/L,(30.14±4.52) ng/L,(1.15±0.11) μg/L] were all higher than those in control group [(68.36±6.36) ng/L,(70.34±7.02) ng/L,(202.17±12.25) μg/L,(56.29±5.48) rng/L,(132.18±11.07) ng/L,(19.45±3.31) ng/L,(0.37±0.07) μg/L],the differences were statistically significant (P ＜ 0.05).②The serum Ang Ⅱ,ET-1,Cor,β-EP,BNP,ACTH and NE in observation group of Ⅳ grade in NYHA [(123.57±10.48) ng/L,(118.84±11.23) ng/L,(307.63±17.26) μg/L,(110.37±10.12) ng/L,(338.26±19.25) ng/L,(43.62±5.17) ng/L,(1.98±0.18) μg/L] were all higher than those of Ⅱ grade [(75.26±7.46) ng/L,(81.72±8.14) ng/L,(229.43±13.54) μg/L,(74.92±6.93) ng/L,(181.35±13.37) ng/L,(22.33±4.22) ng/L,(0.86±0.10) μg/L]and Ⅲ grade [(100.42±9.29) ng/L,(99.28±9.34) ng/L,(268.84±15.92) μg/L,(93.18±7.95) ng/L,(296.42±15.77) ng/L,(32.54±4.65) ng/L,(1.23±0.14) μg/L],the serum Ang Ⅱ,ET-1,Cor,β-EP,BNP,ACTH and NE in Ⅲ grade were all higher than those of Ⅱ grade,the differences were statistically significant (P ＜ 0.05).③The correlation was found among the serum Ang Ⅱ,ET-1,Cor,β-EP,BNP,ACTH,NE and cardiac functional grading (P ＜ 0.05).Conclusion The neuroendocrine hormone levels have close relationship with severity degree of heart failure in elderly patients with hypertension and heart failure,these detection is helpful for the understanding the cardiac status of patients.
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