普伐他汀短期治疗充血性心衰对炎症因子的影响

Effects of Pravastatin in Short-term Treatment of Congestive Heart Failure on Inflammatory Factors

目的观察短期普伐他汀治疗对慢性心衰患者血浆肿瘤坏死因子(TNF-α),高敏C反应蛋白(hs-CRP)和白介素-6(IL-6)的影响,并分离外周血单个核细胞(PBMC),观察普伐他汀对单核细胞分泌IL-6的影响,探讨普伐他汀在慢性心力衰竭中的作用。方法 32名慢性心衰患者被随机分为A、B组。A组接受常规治疗(对照组,n=14),B组在常规治疗的基础上加用普伐他汀20mg/d治疗2周(普伐他汀治疗组,n=18)。在治疗前后分别检测左室舒张末期内径(LVED)和射血分数(LVEF),血浆TNF-α、hs-CRP和IL-6的浓度,同时分离外周血单个核细胞,检测培养上清液IL-6的浓度。心功能测定是应用彩色超声诊断仪进行左室功能的测定,LVEF应用Simpson法在四腔心切面测定。血浆TNF-α,血浆IL-6和上清液IL-6的浓度,均采用夹心酶联免疫吸附测定法(enzyme-linked immunosorbent assay,ELISA)测定。结果经治疗2周后,对照组的血脂水平无显著性变化。与治疗前相比,普伐他汀治疗组对慢性心衰患者的TC和LDL明显下降,均达到显著性差异(P<0.05)。与治疗前比较,对照组和普伐他汀组LVEF均未达到显著性差异。经治疗2周后,与治疗前比较,对照组和普伐他汀治疗组血浆hs-CRP水平,血浆TNF-α浓度,血浆IL-6浓度均显著降低(P<0.01)。与对照组相比,普伐他汀组血浆hs-CRP水平、血浆TNF-α浓度以及血浆IL-6浓度下降更为明显(P<0.05)与治疗前比较,对照组和普伐他汀治疗组外周血单个核细胞分泌的IL-6浓度均显著下降(P<0.01)。与对照组相比,外周血单个核细胞分泌的IL-6浓度下降更为明显(P<0.05)。结论普伐他汀短期治疗充血性心力衰竭能够降低血浆hs-CRP、TNF-α、IL-6,并可抑制外周血单个核细胞分泌IL-6,但不影响患者的心功能。提示普伐他汀在慢性心力衰竭中具有抗炎作用,可能与抑制单核细胞的活性有关。

Objective To investigate the effects ofpravastatin in short-term treatment ofpatients with congestive heart failure（CHF） on tumornecrosisfactor-α（TNF-α）,highsensitivityC-reactive protein（hs-CRP） as well as IL-6.The peripheral blood mononuclear cells（PBMC） were isolated to measure the supernatant IL-6 after treatment with pravastatin.Methods A total of 32 patients with CHF were randomly divided into pravastatin group（pravastatin 20 mg/d） on top of standard therapy（n=18） and control group（standard therapy,n=14） and followed two weeks.The changes on cardiac function,plasma TNF-α level,hs-CRP,and IL-6 were determined before and after therapy,at the same time,IL-6 secretion were measured by PBMC culturing.The levels of TNF-α,IL-6 in plasma and IL-6 in supernatants of PBMC were measured by enzyme-linked immunosorbent assay（ELISA）.Results The serum cholesterol level decreased significantly after two weeks＇ treatment with pravastatin（P 0.05）.No significant changes in LVEF were observed in both control and treatment groups.The levels of hs-CRP,TNF-α and IL-6 decreased significantly in both groups after 2 weeks＇ treatment（P 0.01）,and the decreases were more prominent in the pravastatin group compared to the control group（P 0.05）.IL-6 secretion by PBMC from patients with CHF decreased in both groups（P 0.01）,with more decrease in the pravastatin group compared to control group（P 0.05）.Conclusion Pravastatin in short-term treatment of CHF can reduce the plasma levels of TNF-α,hs-CRP,and IL-6,in addition,pravastatin significantly inhibites IL-6 secretion by PBMC from patients with CHF,which may contribute to the anti-inflammatory effect of pravastatin.