老年慢性心力衰竭患者外周血CD14^(dim)CD16^+单核细胞和血清C反应蛋白水平的变化

Changes in peripheral blood CD14^(dim)CD16^+ monocyte count and serum C-reactive protein level in elderly patients with chronic heart failure

目的·观察老年慢性心力衰竭(CHF)患者外周血CD14^(dim)CD16^+单核细胞和C反应蛋白(CRP)水平的变化,分析其与患者心功能的关系。方法·选取42例老年CHF患者(CHF组:NYHAⅡ级18例,NYHAⅢ级18例,NYHAⅣ级6例)和25名健康老年人(对照组)作为研究对象,分别测定外周血CD14^(dim)CD16^+单核细胞和血清CRP水平、左室射血分数(LVEF)和左室舒张末期内径(LVEDD),并进行统计学分析。结果·CHF组外周血CD14^(dim)CD16^+单核细胞和血清CRP水平均显著高于对照组(P<0.05)。在CHF组中,与NYHAⅡ级患者比较,NYHAⅣ级患者外周血CD14^(dim)CD16^+单核细胞和血清CRP水平及LVEDD均显著增高,而LVEF显著降低,差异均有统计学意义(P<0.05)。相关分析结果显示,CHF组外周血CD14^(dim)CD16^+单核细胞和血清CRP水平与LVEDD呈正相关(r=0.37,r=0.45,P<0.05),与LVEF呈负相关(r=-0.56,r=-0.33,P<0.05)。结论·老年CHF患者的病情加重与炎症有关,在心力衰竭的过程中可能存在单核细胞功能异常。外周血CD14^(dim)CD16^+单核细胞和血清CRP水平有望成为反映心力衰竭严重程度再分层的新型生物标志物。

Objective · To observe the changes in peripheral blood CD14dimCD16＋ monocyte count and serum C-reactive protein （CRP） level in elderly patients with chronic heart failure （CHF） and analyze the relationship between these changes and the cardiac function of patients. Methods · 42 elderly patients with CHF （the CHF group, consisting of 18 cases of NYHA cardiac function grade Ⅱ, 18 cases of NYHA cardiac function grade Ⅲ, and 6 cases of NYHA cardiac function grade Ⅳ） and 25 healthy elderly people （the control group） were enrolled. Peripheral blood CD14dimCD16＋ monocyte count, serum CRP level, left ventricular ejection fraction （LVEF）, and left ventricular end-diastolic diameter （LVEDD） were measured and statistical analysis was performed. Results · CD14dimCD16＋ monocyte count and serum CRP level were significantly higher in the CHF group than in the control group （P〈0.05）. In the CHF group, the CD14dimCD16＋ monocyte count, serum CRP level, and LVEDD of NYHA grade Ⅳ patients were significantly higher than those of NYHA grade Ⅱ patients, while their LVEF was remarkably lower than that of NYHA grade Ⅱ patients. The differences were statistically significant （P〈0.05）. Correlation analysis results showed that peripheral blood CD14dimCD16＋ monocyte count and serum CRP level were positively correlated with LVEDD （r =0.37, r =0.45, P〈0.05） and negatively correlated with LVEF （r=-0.56, r =-0.33, P〈0.05） in the CHF group. Conclusion · The deterioration of elderly patients with CHF is associated with inflammation and the monocyte dysfunction may exist in the heart failure process. Peripheral blood CD14dimCD16＋ monocyte count and serum CRP level are expected to be novel biomarkers that can reflect the severity of heart failure.