慢性充血性心力衰竭患者促炎性细胞因子和心肌纤维化与心功能分级的相关性研究

Relationship of serum cytokine levels and myocardial fibrosis with cardiac funciton in patients with chronic heart failure

目的分析慢性充血性心力衰竭(CHF)患者血清促炎性细胞因子(IL-6、TNF-α)和心肌纤维化指标(PCⅢ、HA、LN)及其与心功能分级的关系;探讨血管紧张素转换酶抑制剂'(ACEI)对CHF患者促炎性细胞因子和心肌纤维化水平调控作用。方法采用放射免疫平衡法和流式细胞仪的液相蛋白定量技术检测113例CHF患者及正常对照组38例血清促炎性细胞因子(IL-6、TNF-α)和心肌纤维化指标(PCⅢI、HA、LN)浓度,并作相关性分析。结果CHF组血清促炎性细胞因子(IL-6、TNF-α)和心肌纤维化指标(PCⅢ、LN、HA)显著高于正常对照组(P<0.05),且随着心功能的恶化而逐渐升高,血清促炎性细胞因子和心肌纤维化指标在不同心功能分级间(心功能Ⅱ、Ⅲ、Ⅳ级)比较均有显著性差异(P<0.05);血清促炎性细胞因子和心肌纤维化指标之间、心功能分级与血清促炎性细胞因子和心肌纤维化指标之间呈显著正相关;ACEI治疗组患者血清促炎性细胞因子和心肌纤维化指标水平较常规治疗组降低更明显,两组治疗后与治疗前比较、ACEI治疗组与常规治疗组比较差异均有统计学意义(P<0.05)。结论促炎性细胞因子的上调及心肌纤维化的程度与CHF的发生、发展、转归之间存在着一定的关联,与心衰严重程度密切相关;ACEI对CHF患者促炎性细胞因子和心肌纤维化水平具有调控作用。

Objective To investigate the relationship of serum eytokine levels （IL-6, TNF—α） and myocardial fibrosis （ PC Ⅲ, HA, LN） with cardiac function in patients with chronic heart failure （CHF）. Methods Serum concentrations of cytokinelevels （IL-6, TNF—α） and serum myocardial fibrosis （PC Ⅲ, HA, LN） in 113 cases with CHF patients and 38 cases normalcontrol group were measured using radioimmunoassay balance method and CBABD-pharmingen Cytometric Bead Array （CBA）, and for correlation analysis. Results CHF serum cytokines （IL-6, TNF—α） and myocardial fibrosis index （PC Ⅲ, LN, HA） was significantly higher than the normal control group （P 〈0. 05 ）, and with the deterioration of cardiac function gradually ncreased, serum eytokines and myocardial fibrosis in different indicators of cardiac function between the （ cardiac functiongrade Ⅱ, Ⅲ ,Ⅳ level） compared were significantly different （P 〈0. 05 ）; Serum cytokines and myocardial fibrosist indicators, cardiac function and serum eytokines and myocardial fibrosis indicators were significantly correlated; ACEI treatment group serum cytokine levels and myocardial fibrosis index lower than the conventional treatment group, mor - obviously, the two groups after treatment compared with before treatment, ACEI treatment group compared with the conventional treatment group were significantly different （P 〈0. 05）. Conclusion Cytokineimbalance and the extent of myocardial fibrosis and the CHF occurrence, development, and the vesting have a certain relevance, and are related to the severity of heart failure; ACEI has a regulating role for cytokine levels and myocardial fibrosis in patients with CHF.