作者：张靖琦 ，万永伦 ，富路

单位：

1.150001黑龙江省哈尔滨市，哈尔滨医科大学附属第一医院心血管内科　2.150001黑龙江省哈尔滨市第二医院心血管 内科

单位（英文）：

1.Development of Cardiovascular Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China 2.Development of Cardiovascular Medicine, the Second Hospital of Harbin, Harbin 150001, China

关键词：

心力衰竭；氨基酸类，支链；心功能；主要不良心血管事件

关键词（英文）：

Heart failure; Amino acids, branched-chain; Cardiac function; Major adverse cardiac events

中图分类号：

R 541.62

DOI：

10.12114/j.issn.1008-5971.2023.00.285

基金项目：

国家自然科学基金面上项目（8207021240）

摘要：

　目的　分析充血性心力衰竭（CHF）患者支链氨基酸（BCAA）水平及其与心功能、主要不良心血管 事件（MACE）的关系。方法　回顾性选取2020年10月至2022年11月哈尔滨医科大学附属第一医院收治的CHF患者144 例作为CHF组，其纽约心脏病协会（NYHA）分级：Ⅱ级28例，Ⅲ级72例，Ⅳ级44例。另选取同期于哈尔滨医科大学附 属第一医院体检的健康者79例作为对照组。收集研究对象的性别、年龄、BMI，CHF患者冠心病史、高血压史、糖尿病 史、PCI史及入院时心率、NYHA分级，CHF患者入院时、体检者体检时BCAA水平、N末端脑钠肽前体（NT-proBNP） 水平、左心室射血分数（LVEF），CHF患者 MACE 发生情况。根据 CHF患者住院期间 MACE 发生情况，将其进一步分 为MACE亚组（n=51）与非MACE亚组（ n=93 ）。比较 CHF组和对照组性别、年龄、 BMI 、BCAA 水平、NT-proBNP水 平、LVEF；比较不同入院时NYHA分级CHF患者BCAA、NT-proBNP水平及LVEF；采用Pearson相关分析探讨CHF患者 BCAA水平与NT-proBNP水平、LVEF的相关性；采用多因素Logistic回归分析探讨CHF患者发生MACE的影响因素。结果 CHF组BCAA、NT-proBNP水平高于对照组，LVEF低于对照组（P＜0.05）。NYHA分级Ⅲ级的CHF患者NT-proBNP 水平高于NYHA分级Ⅱ级的CHF患者，LVEF低于NYHA分级Ⅱ级的CHF患者（P＜0.05）；NYHA分级Ⅳ级的CHF患者 NT-proBNP水平高于NYHA分级Ⅱ、Ⅲ级的CHF患者，LVEF低于NYHA分级Ⅱ、Ⅲ级的CHF患者（P＜0.05）。Pearson 相关分析结果显示，CHF患者BCAA水平与NT-proBNP水平呈正相关（r=0.647，P＜0.001），而与LVEF无直线相关关系 （r=0.164，P=0.089）。MACE亚组有PCI史者占比、BCAA水平、NT-proBNP水平高于非MACE亚组，心率快于非MACE 亚组，LVEF低于非MACE亚组（P＜0.05）。多因素Logistic回归分析结果显示，PCI史、入院时心率、BCAA水平、 NT-proBNP水平、LVEF是CHF患者发生MACE的影响因素（P＜0.05）。结论　CHF患者BCAA水平升高，其与患者心功 能的关系尚不明确，但其与NT-proBNP水平呈正相关，且其升高是CHF患者发生MACE的危险因素。

英文摘要：

Objective To analyze the levels of branched chain amino acid (BCAA) in patients with congestive heart failure (CHF) and their relationship with cardiac function and major adverse cardiovascular events (MACE) . Methods A total of 144 patients with CHF admitted to the First Affiliated Hospital of Harbin Medical University from October 2020 to November 2022 were retrospectively selected as the CHF group. Their New York Heart Association (NYHA) classifications were as follows: 28 patients with grade Ⅱ, 72 patients with grade Ⅲ, and 44 patients with grade Ⅳ. Another 79 healthy subjects who underwent physical examination in the First Affiliated Hospital of Harbin Medical University during the same period were selected as the control group. Gender, age and BMI of the subjects, history of coronary heart disease, hypertension, diabetes and PCI, heart rate and NYHA grade at admission of CHF patients, BCAA level, N-terminal pro-brain natriuretic peptide (NT-proBNP) level and left ventricular ejection fraction (LVEF) of CHF patients at admission and examiners during physical examination, the occurrence of MACE in CHF patients were collected. According to the occurrence of MACE during hospitalization, CHF patients were further divided into MACE subgroup (n=51) and non-MACE subgroup (n=93) . Gender, age, BMI, BCAA level, NT-proBNP level and LVEF were compared between CHF group and control group. The levels of BCAA and NT-proBNP and LVEF were compared in CHF patients with different NYHA classification at admission. Pearson correlation analysis was used to investigate the correlation between BCAA level and NT-proBNP level and LVEF in CHF patients. Multivariate Logistic regression analysis was used to investigate the influencing factors of MACE in CHF patients. Results The levels of BCAA and NT-proBNP in CHF group were higher than those in control group, and LVEF was lower than that in control group (P < 0.05) . The level of NT-proBNP in CHF patients with NYHA grade Ⅲ was higher than that of CHF patients with NYHA grade Ⅱ, and LVEF was lower than that of CHF patients with NYHA grade Ⅱ(P < 0.05) . The level of NT-proBNP in CHF patients with NYHA grade Ⅳ was higher than that of CHF patients with NYHA grade Ⅱ and Ⅲ, and LVEF was lower than that of CHF patients with NYHA grade Ⅱ and Ⅲ (P < 0.05) . Pearson correlation analysis showed that the level of BCAA in CHF patients was positively correlated with the level of NT-proBNP (r=0.647, P < 0.001) , but not linearly correlated with LVEF (r=0.164, P=0.089) . The proportion of patients with PCI history, BCAA level and NT-proBNP level in MACE subgroup were higher than those in non-MACE subgroup, the heart rate was faster than that in non-MACE subgroup, and LVEF was lower than that in non-MACE subgroup (P < 0.05) . Multivariate Logistic regression analysis showed that PCI history, heart rate at admission, BCAA level, NT-proBNP level and LVEF were the influencing factors for the occurrence of MACE in CHF patients (P < 0.05) . Conclusion The level of BCAA in CHF patients is elevated and the relationship between BCAA and the cardiac function of patients is not clear, but it is positively correlated with the level of NT-proBNP, and the increased BCAA level is a risk factor for MACE in CHF patients.

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