黄芪注射液对充血性心力衰竭患者细胞因子和血管紧张素Ⅱ的影响

Effect of astragalus parenteral solution on cytokines and angiotensinⅡ in patients with congestive heart failure

目的:观察充血性心力衰竭患者细胞因子和神经内分泌激素的变化及黄芪注射液对其影响。方法:①选择1999-02/2000-01中山大学附属第二医院内科住院的心力衰竭患者49例,男31例,女18例,均对治疗方案知情同意。根据纽约心脏协会心功能分级标准,心功能Ⅱ级11例,Ⅲ级22例,Ⅳ级16例。随机将入选患者分为2组:常规治疗组24例和黄芪治疗组25例。选择同期本院门诊健康体检者20人为对照组,男12例,女8例。②常规治疗组采用西医常规治疗。黄芪组在常规治疗基础上给予黄芪注射液静脉滴注,40mL/d,疗程为15d。③采用双抗体夹心ELISA法测定血清肿瘤坏死因子α、白细胞介素6水平。采用放射免疫法测定血清血管紧张素Ⅱ水平。应用彩色心脏超声仪测定心功能指标左室射血分数。④计量资料组间比较采用t检验或单因素方差分析。两变量之间关系采用直线相关分析。结果:心力衰竭患者49例及健康者20人均进入结果分析。①血清肿瘤坏死因子α、白细胞介素6和血管紧张素Ⅱ水平:心力衰竭患者明显高于对照组(P<0.01),升高程度随心功能恶化而加重。常规治疗组和黄芪治疗组治疗后均较治疗前明显下降(P<0.05～0.01),以黄芪治疗组降低幅度更显著(P<0.05～0.01)。②左室射血分数:常规治疗组和黄芪治疗组治疗后均较治疗前升高(P<0.05,P<0.01),以黄芪治疗组升高幅度更显著(P<0.05)。③相关性分析结果:心力衰竭组肿瘤坏死因子α、白细胞介素6和血管紧张素Ⅱ与左室射血分数呈显著负相关(r=-0.63,-0.55,-0.77,P<0.01)。结论:①细胞因子和神经内分泌激素与心力衰竭的发生、发展有关。②黄芪注射液可能直接或间接降低血肿瘤坏死因子α、白细胞介素6和血管紧张素Ⅱ水平,有利于改善心功能。

AIM; To observe the changes of cytokines and neuroendocrine hormone in patients with congestive heart failure and the effect of astragalus parenteral solution on them. METHODS： （1）Forty-nine inpatients with heart failure including 31 males and 18 females in the Department of Internal Medicine of Second Affiliated Hospital, Sun Yat-sen University from February 1999 to January 2000 were selected, and all participants knew and agreed the items. According to the cardiac function stardand of New York Heart Association, 11 patients were grade Ⅱ, 22 patients were grade Ⅲ, 16 patients were grade Ⅳ. Included patients were randomly divided into 2 groups： Routine treatment group（n=24） and astragalus treatment group （n=25）. 20 healthy examinees of the same time in the Clinic were selected as control group including 12 males and 8 females.（2）Patients in the routine treatment group received routine treatment. Patients in the astragalus treatment group received venous injection of astragalus parenteral solution at the base of routine treatment, 40 mL per day..The course of treatment was 15 days. （3） Levels of serum tumor necrosis faetor-a and interleukin-6 were measured with ELISA method. Level of plasma angiotensin Ⅱ was measured with radio-immunity method. Left ventricular ejection fraction of cardiac function index was assayed with echocardiography. （4）Differences among groups were analyzed with t test or one-way analysis of variance. Correlation between two variables was analyzed with linear correlation. RESULTS： Fourty-nine patients with heart failure and 20 healthy examinees were involved in the analysis of results. （1）Levels of tumor necrosis factor-a, interleukin-6 and angiotensin Ⅱ ： They were higher in patients with heart failure than those in the control group （P 〈 0.01）, and elevating degree ,was positively related with the deterioration of cardiac function. They were lower in both groups after treatment than those before the treatment （P〈 0.05-0.01）, and more significant in the astragalus treatment group （P 〈 0.05-0.01）.（2）Left ventricular ejection fraction： It was higher in both groups after treatment than that before treatment（P 〈 0.05 ,P 〈 0.01）, and more significant in the astragalus treatment group （P 〈 0.05）. （3）Correlation analysis： Levels of tumor necrosis factor-a, interleukin-6 and angiotensin Ⅱ were significantly negatively correlated with left ventricular ejection fraction （r=-0.63,-0.55 ,-0.77 ,P 〈 0.01）. CONCLUSION： （1）Both cytokine and neuroendocrine hormone are related with the development of heart failure. （2）Astragalus parenteral solution may ,decrease levels of tumor necrosis factor-a, interleukin-6 and angiotensin Ⅱ directly or indirectly, which helps to iroprove the cardiac function.