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目的探讨老年慢性心功能不全患者高凝状态及D二聚体在临床诊治方面的应用价值。方法选取32例老年无症状性慢性心功能不全(n=32)患者和57例老年症状性心功能不全(n=57)患者(根据美国纽约心脏病学会(NY-HA)分为Ⅱ级、Ⅲ级、Ⅳ级分组),另选取26例健康老人作为对照组(n=26)。免疫比浊法测定血浆D-二聚体水平并测定超声心动图指标,比较各亚组间血浆D-二聚体水平,并进行相关性分析。结果慢性心功能不全患者组血浆D-二聚体水平明显高于健康对照组(P<0.01):不同程度的心功能不全组(NYHA分级Ⅱ-IV级)随着分级的增加,D-二聚体水平显著增高。与正常对照组比较,心功能不全组LAD和LVEDD值均增加,LVEF和LVFS值均减小,差异有统计学意义(P<0.05)。D-二聚体水平与LVEDD、LAD呈正相关(P<0.05),与LVEF、LVFS呈负相关(P<0.05)。结论老年慢性心功能不全患者存在高凝状态,随着心衰程度的加重,高凝状态更为严重。D-二聚体水平和NYHA分级、左室收缩功能参数有良好的相关性,提示D-二聚体水平有助于临床全面的进行病情评估,可作为临床上一项重要的心衰评测指标。同时为老年心功能不全患者抗凝治疗提供了更多的依据。
Objective To investigate the clinical value of hypercoagulable state and D-dimer in elderly patients with chronic heart failure. Methods Thirty-two elderly patients with asymptomatic chronic heart failure (n = 32) and 57 elderly patients with cardiac dysfunction (n = 57) were enrolled in this study. They were divided into two groups according to the New York Heart Association (NY-HA) Ⅲ grade, Ⅳ grade group), and the other 26 healthy elderly people as the control group (n = 26). The level of plasma D-dimer was measured by immunoturbidimetry and the echocardiographic parameters were measured. The level of plasma D-dimer was compared between the two groups and the correlation was analyzed. Results The level of plasma D-dimer in patients with chronic cardiac insufficiency was significantly higher than that in healthy controls (P <0.01). The levels of D-dimer in patients with different grades of cardiac dysfunction (NYHA grade Ⅱ-IV) The level of polymer is significantly higher. Compared with the normal control group, LAD and LVEDD increased, LVEF and LVFS decreased in patients with cardiac insufficiency, the difference was statistically significant (P <0.05). The level of D-dimer was positively correlated with LVEDD and LAD (P <0.05), negatively correlated with LVEF and LVFS (P <0.05). Conclusion There is hypercoagulable state in elderly patients with chronic heart failure. With the aggravation of heart failure, the hypercoagulable state is more serious. D-dimer levels and NYHA classification, left ventricular systolic function parameters have a good correlation, suggesting that D-dimer levels contribute to the clinical comprehensive assessment of the disease, can be used as an important clinical evaluation of heart failure index . At the same time for elderly patients with cardiac dysfunction provides more basis for anticoagulant therapy.