充血性心力衰竭患者细胞粘附分子与B型钠利尿肽的相关性研究

Relationship between Cell Adhesion Molecules and B-type Natriuretic Peptide in Patients with Congestive Heart Failure

目的探讨CHF患者细胞粘附分子与B型钠利尿肽的相关性。方法CHF患者35例,其中扩张性心肌病19例、高血压性心脏病11例、冠心病5例;正常对照组18例,分别测定sICAM-1、白细胞表面CD18的阳性表达率和BNP;采用Accuson Sequoia512超声诊断仪测定左房大小、左室舒张末内径、左室收缩末内径、左室射血分数。结果1.CHF组与正常对照组年龄对比无显著性差异(P>0.05),两组在左房内径、左室舒张末内径、左室收缩末内径、左室EF、sICAM-1、CD18的阳性表达率、BNP值对比有显著性差异(P<0.01);2.CHF组中心功能Ⅱ级、Ⅲ级和Ⅳ级组三组,sICAM-1、CD18经方差分析无显著性差异(P>0.05);心功能Ⅳ级组与Ⅱ级组比较BNP有显著性差异(P<0.01);3.sICAM-1与CD18的阳性表达率及BNP水平呈正相关,Pearson指数分别为0.355(P=0.036)和0.531(P=0.001);4.BNP、CD18与LVEF呈负相关:Pearson指数分别为-0.542(P=0.001)和-0.502(P=0.002);5.BNP值>450pg/ml组(n=18)sICAM-1值及CD18分别为387.61±21.39μg/L和64.73±2.91%,<450pg/ml组(n=17)为314.47±24.10μg/L和52.60±3.91%,两组比较P=0.029和0.017,有显著性差异。结论CHF患者血清sICAM-1及白细胞表面CD18的阳性表达率增加;sICAM-1浓度与BNP呈正相关,提示慢性炎症可能是充血性心力衰竭的发病机制之一。心功能分级各组sICAM-1和CD18无显著性差异。根据BNP值分组显示sICAM-1及CD18有显著性差异。

Objective To explore the changes of levels of serum soluble intereellural adhesion molecule-1 （sICAM-1 ）, the diurnal variation of leukocyte CD18 expression in peripheral blood and the eoneentration of serum B-type natriuretic peptide（BNP） in the patients with chronic congestive heart failure（CHF）, and to explore the relationship between cell adhesion molecules and heart failure degrees. Methods Study included 35 CHF patients [ 19 cases of idiopathic dilated cardiomyopathy, 11 cases of hypertension, 5 cases of coronary heart disease （CHD）] and 18 healthy subjects. Serum sICAM-1 was measured by enzyme-linked immmunosorbent assay （FLISA）. Diurnal variation of leukocyte CD18 expression in peripheral blood was assayed by flow cytometer. Serum BNP was measured by chemiluminescence. The diameter of left atrium （LA）, left ventricle end-diastolic （LVED） and left ventricle end-systolic （LVES） and the left ventricular function were assessed by Doppler echocardiography Accuson Sequoia 512. Results There was no sig- nificant difference in the age between CHF group and control group （ P 〉 0.05）. However, the LA, LVEDV, LVESV, LVEF, sICAM-1, the leukocyte CD18 expression and the concentration of serum BNP were significantly higher in CHF patients than those in control group（ P 〈0.01）. CHF patients were divided into three subgroups： NYHA Fc Ⅱ,Ⅲ and Ⅳ group. There was no significant difference in sICAM-1 and the leukocyte CD18 expression between three groups（ P 〉 0.05）, serum BNP was markedly higher in patients with NYHA Fc Ⅳ than in patients with NYHA Fc Ⅱ （ P 〈 0.01）. There was positive correlation between sICAM-1, CD18 and BNP （r = 0.355, P = 0. 036; r = 0.531, P = 0.001, respectively）. There was negative correlation between BNP, CD18 and LVEF （r= -0.542,P=0.001; r= - 0.502,P= 0.（X）2, respectively）. BNP value 〉450 pg/inl, slCAM-1 and CD18 in this subgroup （n = 18） were 387.61 ± 21.39ug/L and 64.73 ± 2.91%, respectively; in another subgroup （ BNP value 〈 450 pg/ml n = 17） were 314.47 ± 24.10ug/L and 52.60 ± 3.91%, respectively. There was significant difference between two subgroups （ P = 0.029 and 0.017, respectively）. Conclusions Elevated levels of sICAM-1 and CD18 were found in the patients with CHF. Meanwhile, there was a positive correlation between levels of sICAM- 1 and BNP, which indicated that chronic inflammation might be one of mechanisms in the development of CHF. Adhesion molecules might play an important role in the progression of CHF. We found poor correlation associated in sICAM-1 and the leukocyte CD18 expression in different heart function classes of CHF, While, referring to BNP, there was positive correlation between sICAM-1 and CD18 in different heart function classes of CHF.