特发性扩张型心肌病患者血清胆固醇水平的预后意义

作     者：Christ M. Klima T. Grimm W. 杨海涛(译) 孙凯(校) 

作者机构：Klinik für Innere Medizin Kardiologie und Intensivmedizin Philipps University Marburg Baidingerstrafie D35033 Marburg Germany 不详 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2006年第2卷第8期

页      面：23-24页

学科分类：1007[医学-药学(可授医学、理学学位)] 1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：扩张型心肌病患者 胆固醇水平 特发性 预后意义 多元逐步回归分析 左心室射血分数 Cox回归分析 血清 心力衰竭患者 预后预测 

摘      要：Aims: Previous studies indicate that low cholesterol levels are associated with adverse prognosis in heart failure patients, because elevated lipoprotein levels may negate bacterial endotoxin load induced by gastrointestinal congestion. Methods and results: We examined the prognostic significance of lipid levels in a cohort of 422 patients with idiopathic dilated cardiomyopathy(iDCM) [50± 12 years, 342 males, 80 females, left ventricular ejection fraction(LV-EF): 31.6± 10.6% ]. During 42 months of follow-up, 86 patients(20.3% ) died or received a heart transplant. In univariate Cox regression analysis, reduced LV-EF, high New York Heart Association(NYHA) class, and increased LV end-diastolic diameter(LVEDD) were strong risk factors associated with that endpoint, whereas decreased total cholesterol, HDL-cholesterol, and apoprotein I levels were identified as weak risk predictors. After step-wise multivariable analysis, only LVEDD, NYHA class, and LV-EF emerged as parameters independently contributing to the model predicting risk for death or heart transplantation(P 0.05). Cholesterol levels were positively associated with LV-EF and negatively associated with LVEDD(P 0.05). Circulating sCD14 levels, a marker of endotoxin exposure, were related to cholesterol levels(P 0.05) and LV-EF(P 0.05). Conclusion: Decreased cholesterol levels do not independently predict adverse prognosis in patients with iDCM. Our findings indicate that low cholesterol levels are dependent on the severity of cardiac disease.