比索洛尔治疗慢性充血性心力衰竭对血清IL-6和TNF-α水平的影响

Effects of bisoprolol on serum interleukin-6 and tumor necrosis factor-α level in patients with congestive heart failure

目的:探讨β受体阻滞剂比索洛尔治疗充血性心力衰竭(CHF)时对血清白介素-6(IL-6)和肿瘤坏死因子(TNF-α)水平的影响。方法:110例充血性心力衰竭患者随机分为常规治疗组(血管紧张素转换酶抑制+利尿剂+地高辛)和比索洛尔组(常规治疗药物+比索洛尔),随访12周,采用放射免疫分析方法测定两组治疗前后和50例健康体检者(正常对照组)血清中IL-6和TNF-α水平。同时使用核素心室显像测定心衰患者左心室射血分数(LVEF)。结果:CHF患者的血清IL-6和TNF-α水平较正常对照组显著升高,IL-6和TNF-α水平在比索洛尔治疗前与LVEF显著负相关,随着病情的好转其水平逐渐降低,且不同的心功能分级之间有统计学意义。在比索洛尔治疗后,比索洛尔组血清IL-6和TNF-α水平较常规治疗组下降更明显。结论:血清IL-6和TNF-α水平的改变水平在CHF病理生理中起着一定的作用,β受体阻滞剂能抑制CHF患者神经内分泌的过度激活。

AIM： To investigate the levels of the serum interleukin-6（IL-6） and tumor necrosis factor-α （TNF-α） in patients with congestive heart failure （CHF） and to evaluate the beneficial effects of beta-blockers on the above variables. METHODS： Studied 110 patients with CHF randomly treated with routine drugs （ACE Inhibitors, diuretics and vasodilator drugs, n=5.5） or additional beta-blocker biso-prolol（n=55）. The levels of serum IL-6 and TNF-α in above patients with CHF at the different period of the course and in 50 healthy humans were determined by radioimmuno-assay. Simultaneously, the left ventricular ejective fraction （LVEF） of above patients were measured by nuclide ventricular imagery. RESULTS： Compared with control group, the levels of serum IL-6 and TNF-α in patients with CHF were significantly increased during the course. There was a significantly negative correlation between IL-6, TNF-α and LVEF at 12 weeks after the treatment, and there were sig- nificant differences of serum IL-6 and TNF-α level among NYHA Ⅱ, Ⅲ and Ⅳ in CHF patients. The level of serum IL-6 and TNF-α were decreased more significantly in the bisoprolol group than in the routine group （ P 〈 0.05 ） . CONCLUSION： Serum IL-6 and TNF-α level might play an important role in pathogenesis of CHF. Beta-blockers had suppress neurohumoral over activation in patients with CHF.