慢性心力衰竭患者心脏功能与血清细胞因子水平的相关性

Correlation between heart function and neurohormone-cytokine level in patients with chronic heart failure

目的分析慢性充血性心力衰竭患者体液-细胞因子血液水平与心功能的相关性,寻找评估心功能的可靠方法。方法测定45例慢性充血性心力衰竭患者[男28例,女17例,年龄(62±14)岁,心力衰竭组]及20例健康献血者或同期入院心功能正常者(年龄、性别与心力衰竭组差别无显著性,正常组)血清组织坏死因子-α(tumornecrosisfactor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、心房利钠肽和脑钠素水平。结果心力衰竭组血清心房利钠肽,脑钠素,TNF-α,IL-6水平明显高于正常组,差异有显著性意义(F=10.02,98.11,3.62,3.48;P<0.01),且心功能越差,血清心房利钠肽,脑钠素,TNF-α,IL-6水平越高;心力衰竭组血清心房利钠肽(r=0.597)、脑钠素(r=0.627)、TNF-α(r=0.402)、IL-6(r=0.406)水平与左心室舒张末期内径正相关(P均<0.01),与左室射血分数及左室短轴缩短率负相关(r=-0.848～-0.486);血清脑钠素诊断慢性心力衰竭的敏感性(100%)、特异性(95%)、阳性预测值(98%)、阴性预测值(100%)均属最大。结论心力衰竭患者存在血清心房利钠肽、脑钠素、TNF-α、IL-6水平改变,不仅与心力衰竭的临床严重程度密切相关,而且可以间接反映心力衰竭时左室重塑和左室收缩功能,因此血清心房利钠肽、脑钠素、TNF-α。

AIM:To analyze the correlation between the serum concentrations of some neurohormone cytokines and the cardiac function in patients with chronic congestive heart failure,so as to seek the reliable method for evaluating the cardiac function.METHODS:Serum concentrations of tumor necrosis factor alpha(TNF α),interleukin 6(IL 6),atrial natriuretic peptide(ANP) and brain natriuretic peptide(BNP) were detected in 45 patients with chronic heart faliure(CHF)[28 males and 17 females,aged(62±14) years old,CHF group] and 20 heathy blood donator or the inpatients with normal cardiac function at the same period.There were no significant differences in the age and gender between the two groups.RESULTS:①Concentrations of sera ANP,BNP,TNF αand IL 6 in the CHF group were obviously higher than those in the normal group,and there were significant differences(F=10.02,98.11,3.62,3.48,P< 0.01);the worse the cardiac function,the higher the serum TNF α,IL 6,ANP and BNP concentrations.The serum concentrations of ANP(r=0.597),BNP(r=0.627),TNF α(r=0.402) and IL 6(r=0.406) in the CHF group had positive correlation with the left ventricular internal dimension at end diastole(LVED)(P< 0.01),and had negative correlation with ejection fraction(EF) or fraction shorten(FS)(r=-0.848 to-0.486).The concentration of BNP was perfect in diagnosis of the sensitivity(100%),specificity(95%),positive predictive value(98%) and negtive predictive value(100%) of CHF.CONCLUSION:There are some changes in the serum concentrations of ANP,BNP,TNF αand IL 6 in patients with CHF,which are not only closely related with the clinical severity of CHF,but also can directly reflect the rebuilding and systolic fraction of left ventricle.Therefore,serum concentrations of ANP,BNP,TNF αand IL 6 can be taken as the parameters of clinical judgement of CHF and monitoring the curative effect of CHF,among which the serum level of BNP is the best.