心力衰竭患者血液细胞因子与心功能的关系(英文)

Relationship between cytokines and heart function in patients with congestive heart failure

背景:充血性心力衰竭血清中一些细胞因子如白细胞介素6和肿瘤坏死因子α以及神经激素如去甲肾上腺素对于心力衰竭发生发展过程中是否起到重要作用。目的:探讨心力衰竭患者血清肿瘤坏死因子α、白细胞介素6,去甲肾上腺素的变化及意义,为判定心力衰竭严重程度及预后提供依据。设计:病例对照研究。单位:上海市市东医院心内科。方法:选择2000-01/2001-10上海市市东医院心内科住院心力衰竭患者58例(患者组),男33例,女25例。按纽约心脏病学会心功能分级,其中Ⅱ级12例,Ⅲ级32例,Ⅳ级14例。选择同期本院自愿健康体检者30例为对照组,男18例,女12例。采用酶联免疫双抗体夹心法测定血清肿瘤坏死因子α,白细胞介素6,去甲肾上腺素水平,用二维心脏超声测定左室射血分数,以此来观察血清细胞因子与心功能之间的关系。结果:①心功能Ⅲ级,Ⅳ级患者血清白细胞介素6[(367.6±78.6),(569.7±117.3)ng/L],肿瘤坏死因子α[(395.3±82.4),(583.1±124.8)ng/L],NE[(396.5±85.3),(675.9±136.2)ng/L]水平明显高于心功能Ⅱ级和对照组[(221.5±58.4),(170.2±42.7)ng/L;(205.4±59.2),(180.3±43.8)ng/L;(227.4±65.6),(163.8±41.5)ng/L,P均<0.05]。心功能Ⅱ级患者与对照组比较,差异无显著性意义(P>0.05)。②白细胞介素6,肿瘤坏死因子α,去甲肾上腺素与左室射血分数呈高度负相关(r=-0.63,P<0.01;r=-0.54,P<0.05;r=-0.58,P<0.01)。心力竭衰程度越重,血清肿瘤坏死因子α,白细胞介素6和去甲肾上腺素水平越高。肿瘤坏死因子α与去甲肾上腺素,白细胞介素6与去甲肾上腺素呈明显正相关(r=0.57,P<0.01;r=0.51,P<0.05)。心力衰竭患者心力衰竭越重,血清白细胞介素6与肿瘤坏死因子α水平越高,且两者呈正相关(r=0.39,P<0.05)。结论:心力衰竭患者血清肿瘤坏死因子α和白细胞介素6水平均升高,尤其在中重度心力衰竭患者中更加明显,并与左室射血分数呈负相关,提示血清白细胞介素6、肿瘤坏死因子α水平可作为心力衰竭严重程度判断与预后的指标,并为康复干预措施介入提供量化评估依据。

BACKGROUND: There are some cytokines like interleukin-6, tumor necrosis factor-alpha as well as neurohormones such as norepinerphrine in serum of patients with congestive heart failure. However, whether they influence the occurrence and development of congestive heart failure is uncertain. OBJECTIVE: To explore the changes and significance of interleukin-6, tumor necrosis factor-alpha and norepinerphrine in order to provide basis for assessing the severity of heart failure and its prognosis. DESIGN: A case control study. SETTING: Department of Cardiology, Shidong Hospital of Shanghai City. INTERVENTIONS: A total of 58 patients with congestive heart failure admitted to Department of Cardiology, Shidong Hospital of Shanghai City from January 2000 to October 2001 were chosen as patient group with 33 males and 25 females. According to NYHA heart function classification, there were 12 cases of level II, 32 cases with level III and 14 cases of level IV. Thirty healthy volunteers who took physical examination during the same time were chosen as control group with 18 males and 12 females. ELISA was used to assay the levels of interleukin-6, tumor necrosis factor-alpha and norepinerphrine in serum while two-dimension echocardiography was used to test the left ventricular ejection fraction in order to observe the relationship between cytokines and heart function. RESULTS: ① The levels of interleukin-6 [(367.6±78.6), (569.7±117.3) ng/L], tumor necrosis factor-alpha [(395.3±82.4), (583.1±124.8) ng/L] and norepinerphrine [(396.5±85.3),(675.9±136.2) ng/L] in patients with level III, IV heart function was remarkably higher than those of patients with level II heart function and people in control group[(221.5±58.4), (170.2±42.7) ng/L; (205.4±59.2), (180.3±43.8) ng/L; (227.4±65.6),(163.8±41.5) ng/L] (P < 0.05). Compared patients of level II heart function with people in the control group, there was no difference on the above indicators (P > 0.05). ②There was highly negative correlation between interleukin-6, tumor necrosis factor-alpha, norepinerphrine and left ventricular ejection fraction (r=-0.63, P< 0.01; r=-0.54, P< 0.05;r=-0.58,P < 0.01). The more severe the heart failure, the higher the levels of interleukin-6, tumor necrosis factor-alpha and norepinerphrine. There was obviously positive correlation between tumor necrosis factor-alpha and norepinerphrine as well as between interleukin-6 and norepinerphrine (r=0.57,P < 0.01;r=0.51,P < 0.05). The more severe the heart failure, the higher the level of interleukin-6 and tumor necrosis factor-alpha and that there was positive correlation between them (r=0.39, P < 0.05). CONCLUSION: The tumor necrosis factor-alpha and interleukin-6 levels in patients with congestive heart failure all increased, especially in patients with moderate or severe congestive heart failure, and represented negative correlation with left ventricular ejection fraction. It suggests that the levels of interleukin-6, tumor necrosis factor-alpha in serum can be used as indicators to assess the severity and prognosis of congestive heart failure and provide assessment basis for quantitative evaluation of rehabilitation interventions.