老年退行性心脏瓣膜病患者免疫炎症因子的观察

Serum levels of immunoinflammatory factors in patients with senile degenerative heart valvular diseases

目的:探讨免疫炎症反应在老年退行性心脏瓣膜病(SDHVD)发生发展中的作用。方法:根据彩色超声多普勒检查结果,将63例SDHVD患者分为单纯主动脉瓣钙化(AVC)组、单纯二尖瓣钙化(MVC)组、主动脉瓣钙化合并二尖瓣钙化(AVC+MVC)组,24例无心脏瓣膜钙化的老年患者设为对照组;并同时记录各组左房、左室大小及左室收缩与舒张功能参数。采用放射免疫法测定各组患者血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)的含量,采用微粒子酶免疫分析法(MEIA)检测血清脑钠肽浓度,同时利用透射比浊法测定血清免疫球蛋白(IgG、IgA、IgE)的含量。结果:AVC组、MVC组、AVC+MVC组与对照组相比TNF-α、IL-1β、IL-6、IgE均有明显升高,且与脑钠肽呈正相关,与左室射血分数呈负相关。结论:免疫炎症反应参与了SDHVD的发生与发展,监测血清TNF-α、IL-1β、IL-6、IgE的浓度有助于SDHVD的早期诊断和探讨新的干预措施。

Objective：To investigate the effects of immunoinflammatory reaction on the progression of senile degenerative heart valvular disease（SDHVD）.Method：Sixty three patients above the age of 60 with valvular calcification evaluated by doppler ultrasound were divided into the simple aortic valve calcification group（AVC,n=23）;the simple mitral valve calcification group（MVC,n=19）;the allied valve calcification group（AVC＋MVC,n=21）,and the control group（NVC,n=24）.The volum of left atrials,left vetricules,indexes about systemic and diastolic functions were detected.The levels of serum tumor necrosis factor-alpha（TNF-α）,interleukins-1β（IL-1β） and interleukins-6（IL-6） were measured by radioimmunoassay（RIA）.The BNP level was measured by microparticle enzyme immunoassay.The concentration of serum immunoglobulins was measured by immunoturbidimetic method.Result：Serum TNF-α,IL-1β,IL-6 and IgE concentrations in the groups of AVC,MVC,AVC＋MVC were all significantly higher than that in the NVC group.Meanwhile,they were negatively related to the left ventricular ejection fraction（LVEF） and were positively related with BNP.However they had no significant different between AVC,MVC and AVC＋MVC groups.Conclusion：Immunoinflammatory factors play an important role in the progress of senile degeneration heart valvular disease.Serum concentrations of TNF-α,IL-1β,IL-6,IgE were helpful for early diagnosis of SDHVD as well as investigating new therapeutic methods.