心力衰竭患者循环TNF-α、ET-1、Adm水平及萘哌地尔对其影响

Levels of tumor necrosis factor-α,adrenomedullin and endothelin-1 in the patients with chronic heart failure and the effect of naftopidil

目的探讨心力衰竭患者循环肿瘤坏死因子 α(TNF α)、肾上腺髓质素 (Adm)、内皮素 1(ET 1)水平及萘哌地尔对其影响。方法采用放免法检测 5 4例心力衰竭患者 (CHF组 )及 2 0例健康者 (对照组 )血TNF α、Adm和ET 1浓度 ,同时用多普勒超声心动图测定左室射血分数 (LVEF)。然后将 5 4例心力衰竭患者随机分为两组 :常规治疗组 (A组 ) 2 8例 ,给予常规抗心力衰竭治疗 ;萘哌地尔治疗组 (B组 ) 2 6例 ,在A组药物治疗的基础上加服萘哌地尔 5 0mg ,每日 2次 ,1月后重复上述检查。结果①心力衰竭患者TNF α、Adm和ET 1水平显著高于对照组 (P <0 0 1) ,三个参数分别与LVEF呈负相关 (P <0 0 1)。②A组和B组治疗后与治疗前比较 ,TNF α、Adm和ET 1水平下降和LVEF、NYHA分级改善显著 (P <0 0 1)。③B组治疗后和A组治疗后比较 ,TNF α、ET 1水平进一步下降 (P <0 0 1)及NYHA分级进一步改善 (P <0 0 5 ) ,而Adm水平下降和LVEF提高差异无显著性(P >0 0 5 )。结论TNF α、Adm和ET 1与心力衰竭的发生发展可能有一定关系 ,萘哌地尔治疗可进一步降低心力衰竭患者TNF α、ET 1水平及改善临床症状。

Objective To investigate the levels of tumor necrosis factor-α(TNF-α),adrenomedullin (Adm) and Endothelin-1(ET-1) in the patients with chronic heart failure and the effect of naftopidil. Methods The levels of TNF-α,ET-1 and Adm , and left ventricular fraction(LVEF) on 54 patients with chronic heart failure(CHF group) and 20 healthy subjects (control group) were measured by radioimmunoassay and Doppler echocardiography respectively. The patients were randomized to receive naftopidil (50mg Bid) in addition to routine therapy (B group, n=26) or routine therapy only (A group, n=28). Results 1.The levels of TNF-α, Adm and ET-1 of the CHF group were higher than those of the control group(P<0.01). There were significantly inverse correlations between TNF-α, Adm , ET-1 and LVEF(respectively P<0.01). 2. The levels of TNF-α, ET-1, Adm and LVEF, NYHA of the both groups after treatment were significantly decreased and improved than before treatment(P<0.01).Conclusion TNF-α, Adm, ET-1 could play an important role in the pathophysiologic changes of CHF. Naftopidil could further decrease the levels of TNF-α、ET-1 and improve the symptoms of CHF.