慢性心力衰竭中细胞因子的变化及其临床意义

Study of the changes of serum levels of cardiac function in patients with chronic heart failure

目的观察肿瘤坏死因子α(TNF-α)、白介素6(IL-6)、C-反应蛋白(CRP)、转化生长因子-β1(TGF-β1)在慢性心力衰竭(CHF)患者中的变化及其临床意义。方法抽取49例基础疾病为缺血性心脏病、扩张型心肌病及高血压性心脏病的CHF患者和30例健康体查者的血清,用酶联免疫检测法(ELISA)测定血清TNF-α、IL-6及TGFβ-1浓度,用速率散射比浊法测定CRP浓度,超声心动图测定左室射血分数(LVEF),并进行比较分析。结果CHF患者血清TNF-α、IL-6和CRP水平明显高于健康对照组(P<0.01),并与LVEF呈显著负相关(r=-0.72,P<0.01;r=-0.78,P<0.01;r=-0.81,P<0.01)。CHF患者血清TGFβ-1水平明显低于健康对照组(P<0.01),并与LVEF呈显著正相关(r=0.74,P<0.01)。且心衰越重,上述变化越明显。结论CHF患者细胞因子网络失衡,炎性反应因子升高,抗炎因子降低,失衡的细胞因子网络参与了CHF的发生和发展。细胞因子的浓度可以作为CHF患者评估的参考指标。

Objective To investigate the changes of serum tumor necrosis factor-a（TNF-a） ,interleukin-6（IL- 6） , C reaction protein（CRP） and transforming growth factor-β1（TGF-β1） and their relationship with the cardiac function in the patients with chronic heart failure（CHF）. Methods Serum samples of 49 patients with CHF secondary to isehemic heart disease, idiopathic dilated cardiomyopathy and essential hypertension and 30 healthy blood donors were collected. The serum levels of TNF-α ,IL-6 and TGF-β1 were measured by enzyme-linked immunoassay, CRP by turbidimetry assay of speed dispersion and left ventricular ejection fraction （LVEF） by echocardiography. Results In patients with CHF,when compared with healthy controls, the serum levels of TNF-α , IL-6 and CRP were markedly increased（P〈0.01）, while TGF-β1 significantly decreased （P〈0.01） along with increasing NYHA functional class（P〈0.01）. TNF-α ,IL-6 and CRP were negative but TGF-β1 positively correlated with LVEF（r=- 0.72,P〈0.01;r=-0.78,P〈0.01;r=-0.81,P〈0.01;r=0.74, P〈0. 01）. Conclusion There were significant correlations between the serum levels of TNF-α,IL-6,CRPand TGF-β1 and the severity of CHF. The dysbalance of cytokine network may play a role in the development and progression of CHF. The levels of cytokines can act as consultative parameters for the clinical evaluation of the patients with CHF.