充血性心力衰竭患者细胞免疫功能失调的探讨

The Investigation of Cell-mediated Immunity Dysfunction in Patients with Congestive Heart Failure

目的探讨充血性心力衰竭(CHF)患者外周血辅助性T淋巴细胞功能失调及其在心力衰竭发生及发展中的意义。方法选择62例CHF患者作为研究组,其中,心功能Ⅱ级28例,Ⅲ级16例,Ⅳ级18例;30例健康志愿者作为对照组。采用流式细胞分析法,检测所有被检者外周血CD4+细胞胞内细胞因子干扰素γ(IFN-γ)和白细胞介素4(IL-4)的表达。同时分离外周血单个核细胞,经植物血凝素(PHA)刺激培养后,应用酶联免疫吸附方法(ELISA)检测培养上清液中IFN-γ和IL-4水平。结果CHF组患者IFN-γ染色阳性的细胞占CD4+T细胞的比率为17.48%,明显高于对照组的12.09%。IL-4染色阳性细胞比率两组间未见显著差异。ELISA检测显示心力衰竭组培养上清液中IFN-γ水平及IFN-γ/IL-4比值明显高于对照组,而两组间IL-4水平则无显著差异。结论心力衰竭患者辅助性T淋巴细胞功能与心功能之间有一定关系,辅助性T淋巴细胞功能失调可能参与了CHF患者的心室重构过程。

Objective To explore the significance of cell - mediated immunity dysfunction in patients with congestive heart failure. Methods Sixty-two patients with congestive heart failure were investigated and divided into 3 groups according to the New York Heart Association （ NY- HA）, and thirty healthy volunteers were studied as control. The heart function was evaluated by two-dimensional echocardiography. Peripheral blood mononuclear cells （PBMCs） were collected from these patients. Cytokine-producing CD4^＋ T cells were quantified by 3-color flow cytometry, after stimulated with phorbol myristate acetate （PMA） and ionomycin. After PBMCs being stimulated with PHA, the levels of IFN-γ and IL-4 in culture supemarants were measured by ELISA. Results The ratios of IFN-γ-preducing T cells were found to be significantly higher in congestive heart failure group（ 17.48% ） than those in control group（ 12.09% ）. There was no significant difference in the ratios of IL-4-producing peripheral T-lymphocytes between the two groups.The level of IFN-γ and the ratios of IFN-γ/IL-4 in congestive heart failure group were significantly higher than those in control,while there was no significant difference in IL-4 level between the two groups. Conclusion The cell-mediated immunity function was associated with heart function in patients with congestive heart failure, suggesting that cell-mediated immunity dysfunction may participate in ventricular remodeling after heart failure.