血浆细胞因子水平与老年慢性心力衰竭患者多器官功能衰竭的关系

Relationship between plasma cytokine expression and multiple organ failure in elderly patients with chronic heart failure

目的 探讨老年慢性心力衰竭 (CHF)时多器官功能衰竭 (MOF)的发生与血浆细胞因子的关系。方法 6 2例老年CHF者 ,男 4 4例 ,女 18例 ,平均年龄 (70± 13)岁。根据是否合并MOF分为单纯CHF组和CHF +MOF组 ,各 31例 ;再根据治疗后是否存活分为存活及死亡两个亚组。另设正常对照组 31例。分别于入院时和治疗后测定左室射血分数 (LVEF) ,血浆肿瘤坏死因子α(TNFα)、白介素 1β(IL 1β)、可溶性细胞间粘附分子 1(sICAM 1)、心钠素 (ANP)水平。结果 血浆中TNFα ,IL 1β ,sICAM 1水平在存活与死亡之间比较 ,MOF组较CHF组明显升高 ;而组内比较 ,死亡者又较存活者明显增加。CHF组与MOF组在同是存活或死亡之间比较 ,LVEF和ANP无明显差异 ,但两组内存活和死亡者之间比较 ,在治疗后则有明显差异 ;两组治疗后与治疗前比较均有明显差异 ,存活者改善而死亡者恶化。结论 细胞因子TNFα,IL 1β ,ICAM 1的血浆水平增加与MOF的发生发展密切相关 ,通过检测血浆中上述细胞因子的水平 ,可作为判断有无MOF及其严重程度的指标。

Objective To investigate the relationship between plasma cytokine expression and the development of multiple organ failure (MOF) in elderly patients with chronic heart failure (CHF). Methods A total of 62 CHF patients 〔44 male, 18 female with an average age of (69.6±12.5) years old〕were equally distributed into two groups: CHF group and CHF+ MOF group .Both groups were subdivided into survived and deseased patients subgroup after therapy. Additional 31 normal cases were selected as the control. The expression of plasma tumor necrosis factor α(TNFα),interleukin 1β(IL 1β), soluble intercellular adhesion molecule 1 (sICAM 1), atrial natriuretic peptide(ANP),and left ventricular ejection fraction(LVEF) were measured on admission and after treatment.Results The plasma expressions of TNFα,IL 1β,and sICAM 1 were significantly higher in CHF+MOF group than in CHF group, and they were higher in the deseased subgroup than in the survived one, too. No significant differences of the LVEF and plasma ANP concentrations were found between CHF group and CHF+MOF one;but there were significant differences between the survived and the deseased subgroup after treatment. Conclusions The higher expression of plasma TNFα,IL 1β,sICAM 1 (but not ANP) were independent risk factors of MOF. The development of MOF could be predicted by measuring plasma expression of these cytokines.