男性心力衰竭患者血清雄激素与细胞因子及活化蛋白的关系

Association of serum androgen level with cytokines and activator protein-1 in male chronic heart failure patients

目的探讨男性心力衰竭(心衰)患者血清雄激素与细胞因子及活化蛋白(activator protein-1,AP-1)的关系。方法选择160例男性心衰患者作为心衰组,心功能(NYHA)Ⅱ级40例,Ⅲ级55例,Ⅳ级65例,同期选择40例健康体检男性作为对照组,ELISA法检测外周血游离睾酮(FT)、总睾酮(TT)、去氢表雄酮(DHEA)、去氢表雄酮硫酸酯(DHEAS),白细胞介素(IL)-1β、IL-6、TNF-α、IL-10及AP-1的水平,进行相关分析。结果心衰组血清FT[(42.76±8.46)pmol/L vs(51.25±4.71)pmol/L]、TT[(14.26±3.65)nmol/L vs(17.98±2.59)nmol/L]、DHEA[(6.63±1.43)nmol/Lvs(6.39±1.39)nmol/L]、DHEAS[(1.77±0.59)nmol/Lvs(2.28±0.43)nmol/L]及IL-10水平显著低于对照组,随心功能Ⅱ级、Ⅲ级到Ⅳ级增加逐级显著下降(P<0.05,P<0.01)。心衰组血清IL-1β、IL-6、TNF-α、AP-1水平显著高于对照组,由心功能Ⅱ级、Ⅲ级到Ⅳ级增加而逐级显著升高(P<0.05,P<0.01)。心衰组FT、TT、DHEA、DHEAS与IL-1β、IL-6、TNF-α、AP-1呈负相关(P<0.05,P<0.01),与IL-10呈正相关(P<0.05,P<0.01);FT与AP-1独立负相关(P<0.01)。结论男性心衰患者血清雄激素水平减低,可能与致炎细胞因子增高、抗炎细胞因子减少及AP-1活化有关,低雄激素血症影响男性心衰的发生和发展。

Objective To study the association of serum androgen level with cytokines and activator protein-1 （AP-1） in male chronic heart failure （CHF） patients. Methods One hundred and sixty male CHF patients served as a CHF group and 40 healthy male subjects served as a control group in this study. Their serum levels of free testosterone （FT）,total testosterone （TT）,dehydroepi androsterone （DHEA）,dehydro-epiandrosterone sulfate （DHEAS）,IL-1β,II76 ,TNF-α,IL-10 and AP 1 were measured by ELISA and their association was analyzed. Results The serum levels of FT,TT,DHEA,DHEAS,IL-10 were significantly lower in CHF group than in control group and decreased with the increased NYHA classification from Ⅱ to Ⅲ and Ⅳ （P〈0.05,P〈0.01）. The serum levels of IL-1β,IL-6,TNF-α,AP 1 were significantly higher in CHF group than in control group and increased with the increased NYHA classification from Ⅱ to Ⅲ and Ⅳ （P〈0.05,P〈0.01）. The serum levels of FT,TT,DHEA,DHEAS were negatively related with those of IL-1β, IL- 6,TNF-α,AP-1 （P〈0.05,P〈0.01） and positively related with that of IL-10 （P〈0.05,P〈0.01）. The serum FT level was independently and negatively associated with that of AP-1 （P〈 0.01）. Conclusion Low serum androgen level in male CHF patients is associated with increased proinflammatory cytokines, decreased antiinflammatory cytokines and activated AP-1. Hypoandrogenism have an adverse offect on the occurrence and development of CHF in males.