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目的:探讨肝豆状核变性(HLD)患者心脏标志物改变及其机制。方法:选取未正规治疗的90例HLD患者和30名健康者(对照组)进行心脏标志物检测,分别对比HLD各临床分型、Child-pugh分级组与对照组间的心脏标志物变化,并分析各心脏标志物与血清游离铜的相关性。结果:HLD脑-内脏型心房钠尿肽前体氨基酸片段(NT-proANP)高于对照组(P<0.05),肝型组心肌肌钙蛋白T(cTnT)、NT-proANP、脑钠尿肽前体氨基酸片段(NT-proBNP)高于对照组(P<0.05);Child-pugh B级组与C级组心肌肌钙蛋白I(cTnI)、脑钠尿肽(BNP)、cTnT、心房钠尿肽(ANP)、NT-proANP与NT-proBNP均高于对照组和A级组(均P<0.05)。血清游离铜与cTnI、cTnT、ANP、BNP、NT-proANP及NT-proBNP分别呈正相关,相关系数依次为0.715、0.781、0.777、0.775、0.810及0.720。结论:HLD患者可能存在心肌损伤,且肝硬化程度越严重,心脏标志物各指标升高越明显,游离铜可能参与了对心脏的毒性作用。
Objective: To investigate the changes of cardiac markers in hepatolenticular degeneration (HLD) and its mechanism. Methods: Totally 90 HLD patients and 30 healthy volunteers (control group) who were not regular treatment were enrolled in this study. Cardiac markers were detected in each of the HLD clinical categories, Child-pugh classification group and control group The correlation between each cardiac marker and serum free copper was analyzed. Results: The NT-proANP of HNS was higher than that of the control group (P <0.05), and the levels of cTnT, NT-proANP and BNP (NT-proBNP) were higher than those in the control group (P <0.05). The levels of cTnI, BNP, cTnT and atrial natriuretic peptide in Child-pugh B group and C group The urinary peptide (ANP), NT-proANP and NT-proBNP were higher than the control group and A group (all P <0.05). Serum free copper was positively correlated with cTnI, cTnT, ANP, BNP, NT-proANP and NT-proBNP respectively, and the correlation coefficients were 0.715, 0.781, 0.777, 0.775, 0.810 and 0.720 respectively. Conclusion: Myocardial injury may occur in patients with HLD, and the more serious the degree of liver cirrhosis is, the more obvious the index of cardiac markers increases. Free copper may be involved in the cardiac toxicity.