慢性充血性心力衰竭患者C-反应蛋白、肾上腺髓质素及内皮素-1水平比较

A comparison between C-reactive protein,adrenomedullin and endothelin-1 in patients of chronic congestive heart failure

目的研究心力衰竭时细胞因子激活后C-反应蛋白(CRP)的变化及对肾上腺髓质素(ADM)及内皮素-1(ET-1)等血管活性物质的影响。方法CRP采用散射比浊法测定,ET-1及ADM采用放射免疫分析法测定。对60例失代偿性心功能衰竭患者(心力衰竭组)及30例心功能正常的原发性高血压患者(对照组)血浆CRP、ADM及ET-1的浓度进行测定。结果心力衰竭组血浆CRP、ADM及ET-1浓度较对照组均明显升高；在心力衰竭组,不同心功能(NYHA)分级的患者随心功能衰竭加重,血浆CRP及ADM的浓度均有所升高,而ET-1浓度在不同心功能分级的患者中无显著差异；心力衰竭组患者血浆CRP浓度及ADM浓度呈正相关。结论慢性充血性心力衰竭患者体内存在着细胞因子、ADM及ET-1的激活,细胞因子活化可能通过促进ADM等的合成作用于心力衰竭的体液调节,但与ET-1的活化没有明显的关系。

Objective To study the changes of cytokine activation in patients with chronic congestive haert failure（CHF） as indicated by plasma levels of C-reactive protein（CRP） and its relation to adrenomedullin（ADM） and endthelin-1（ET-1）. Methods The plasma levels of CRP,ADM and ET-1 of 60 decompensated haert failure（DHF） patients group and 30 essential hypertension patients with compensated cardiac function（CCF） group were tested. CRP was determined by immunoturbidometry, ET-1 and ADM were determined by radioimmunoassay. Results The plasma levels of ET-1 ,ADM and CRP of decompensated heart failure group were significantly higher than the compensated cardiac function group;In the decompensated heart failure group,the plasma levels of CRP and ADM were elevated according to worsening of heart failure（NYHA classification）; In the decompensated heart failure group, the plasma levels of CRP were positively correlated with ADM （ r = 0.57）. Conclusion There is extensive activation of cytokines,ADM and ET-1 in patients with chronic congestive heart failure. Cytokine activation might play a role in the synthesis of ADM,thus contribute to the hum oral regulation of heart failure,but may not be responsible for the activation of ET-1.