氯沙坦对心力衰竭患者细胞因子的影响

The effect of losartan on serum cytokine levels in patients with chronic heart failure

目的 观察心力衰竭患者血清肿瘤坏死因子 α(TNF α) ,白细胞介素 6 (IL 6 )的变化 ,以及氯沙坦对上述细胞因子的影响。方法 测定 4 0例正常健康者 (正常对照组 )以及 6 0例心力衰竭患者血清TNF α ,IL 6和血浆血管紧张素Ⅱ (AngⅡ )浓度。随后 6 0例心力衰竭患者被随机分成常规治疗组和常规治疗 +氯沙坦 5 0mg ,每日 1次 (氯沙坦组 )。每组 30例 ,治疗 14d后复测TNF α ,IL 6和AngⅡ浓度。同时应用彩色多普勒超声显像仪测量心力衰竭患者治疗前和治疗 14d后的左心室射血分数 (LVEF)。结果 与正常对照组比较 ,心力衰竭患者血清INF α ,IL 6和血浆AngⅡ浓度明显升高 (P均 <0 0 1) ,TNF α与IL 6与LVEF呈负相关 (r =- 0 6 3,r =- 0 5 9,P均 <0 0 1) ,TNF α与IL 6呈正相关 (r=0 73,P <0 0 1)。治疗 14d后 ,氯沙坦组血清TNF α、IL 6和血浆AngⅡ浓度显著下降 (P均 <0 0 1) ,LVEF升高 (P <0 0 5 ) ,而常规治疗组无明显变化 (P均 >0 0 5 )。结论 心力衰竭患者血清TNF α与IL 6浓度明显升高 ,且与LVEF呈负相关 ,氯沙坦具有降低血清TNF α与IL 6浓度并改善LVEF的作用。

Objective To examine the levels of serum tumor necrosis factor α(TNF α), interleukin 6(IL 6), and study the effects of losartan on the above parameters in patients with chronic heart failure(CHF). Methods Serum levels of TNF α, IL 6 and plasmas angiotensin Ⅱ(AngⅡ) were detected in 40 normal controls and 60 patients with CHF. Sixty patients with CHF were randomized to receive losartan 50 mg in addition to Conventional therapy, or only Conventional therapy for 14 days. Serum TNF α, IL 6 and plasma AngⅡ were detected at baseline and 14 days after treatment. Left Ventricular ejection fractions(LVEF) were measured before and after 14 days of treatment. Results Compared with normal controls, CHF patients had increased in levels of serum TNF α, IL 6 and plasma AngⅡ( P <0 01), and the LVEF was significantly negatively Correlated with the levels of TNF α( r =-0 63, P <0 01) and IL 6( r =-0 59, P <0 01), TNF α positively correlated with IL 6( r =0 73, P <0 01). Administration of losartan was associated with the decreasing of the levels of serum TNF α,IL 6 and plasma AngⅡ( P <0 01). LVEF increased after 14 days of treatment by losartan( P <0 05). Conclusions The levels of serum TNF α, and IL 6 were significantly increased in patients with CHF which were negatively correlated with LVEF. Losartan can modulate the levels of TNF α and IL 6, or improve LVEF in CHF patients.