肿瘤坏死因子-α与心源性恶病质

Elevated circulating levels of tumor necrosis factor α in patients with cachexia of heart failure

目的 :探讨肿瘤坏死因子 (TNF α)与心源性恶病质的关系。方法 :应用放免法检测 6 9例心力衰竭(CHF)患者 (NYHA 2～ 4级 )和 2 2例正常人血浆TNF α,用自动生化分析仪测定血清蛋白。测量患者身高、体重和三头肌皮褶厚度 (TSF)。结果 :心力衰竭患者血浆TNF α明显升高。高TNF α浓度 (≥ 2 2 pmol/L即正常人( x± 2s)的患者体重、TSF和血清蛋白较低TNF α浓度 (<2 2pmol/L)者明显减少 (P <0 .0 5 )。高TNF α浓度组恶病质发生率占 40 % ,而低浓度组仅占 13.7% ,两组比较差异有显著性意义 (P <0 .0 5 )。TNF α含量与体重减轻呈负相关。结论 :TNF

Objective: To study the significance of TNF α on general wasting in patients with chronic heart failure. Method: Sixty nine patients with CHF and 22 healthy age matched controls composed population for measuring plasma levels of TNF α. All patients were clinically stable at the time of evaluation. Demographic body weight, height and thickness of skin folds on triceps (TSF) and biochemical serum total protein and albumin parameters of 47 patients with NYHA heart functional class Ⅲ or IV were listed according to plasma level of TNF α. Result: There were statistical difference in TNF α concentration between CHF and control subjects 〔( 19.61 ± 8.28 ) pmol/L vs ( 12.03 ± 4.83 ) pmol/L,P< 0.01 〕. The patients with high plasma TNF α level tended to develop general wasting (low values in body in weight, TSF or TP and Ab). The ratio of cachexia in high TNF α level group was obviously higher than that of low one (40% vs 13.7 %,P< 0.05 ). The contents of TNF α negatively correlated with weight loss. Conclusion: Elevated circulating level of TNF α in patients with chronic heart failure may play a role in the occurrence of cardiac cachexia.