慢性心力衰竭合并肾损害患者血清白细胞介素1、白细胞介素6水平的变化及临床意义

Serum levels of interleukin-1 and interleukin-6 in patients with chronic heart failure accompanied with renal damage and its clinical significance

目的探讨慢性心力衰竭合并肾损害患者血清白细胞介素1(IL-1)和白细胞介素6(IL-6)水平的变化及其临床意义。方法选取纽约心脏病学会(NYHA)心功能分级在Ⅱ~Ⅳ级的慢性心力衰竭患者220例,测定其血清尿素氮(BUN)、血肌酐(SCr)、N末端B型利钠肽原(NT-pro BNP)及IL-1、IL-6水平,计算肾小球滤过率(e GFR),随机尿检测尿微量白蛋白(MAU),心脏超声测定左室射血分数(LVEF),比较不同心功能患者的IL-1、IL-6、NT-pro BNP、e GFR和MAU,不同肾功能患者的IL-1、IL-6,分析IL-1、IL-6与NYHA心功能分级、NT-pro BNP、LVEF、e GFR及MAU的关系。结果与NYHAⅡ级心功能患者相比,NYHAⅢ~Ⅳ级心功能患者血清IL-1、IL-6、NT-pro BNP水平及MAU升高,e GFR降低(P<0.05),NYHAⅣ级心功能患者IL-1、IL-6、NT-pro BNP水平及MAU高于NYHAⅢ级(P<0.05)。NYHAⅢ~Ⅳ级心功能患者中,30%≤EF≤50%患者血清IL-1、IL-6、NT-pro BNP水平及MAU高于EF>50%患者(P<0.05),e GFR低于EF>50%患者(P<0.05),EF<30%患者IL-1、IL-6、NT-pro BNP水平及MAU高于30%≤EF≤50%患者(P<0.05)。NYHAⅢ~Ⅳ级心功能患者中,肾功能不全组[e GFR<60 m L/(min·1.73 m2)]血清IL-1、IL-6水平高于肾功能正常组[e GFR≥60 m L/(min·1.73 m2)](P<0.05)。不同基础疾病的心力衰竭患者之间IL-1、IL-6水平及e GFR比较,差异无统计学意义(P>0.05)。血清IL-1、IL-6水平与NYHA心功能分级、NT-pro BNP及MAU呈正相关(P<0.05),与e GFR、LVEF呈负相关(P<0.05)。结论慢性心力衰竭患者血清炎症因子IL-1、IL-6水平升高,与心力衰竭的严重程度和肾功能受损相关,测定血清IL-1、IL-6水平可能有助于临床心衰病情的评估。

Aim To explore the serum levels of interleukin-1 （IL-1） and interleukin-6 （IL-6） in patients with chronic heart failure accompanied with renal damage and its clinical significance. Methods 220 New York Heart As-sociation （NYHA） functional class Ⅱ-Ⅳ patients with chronic heart failure were enrolled in this study. Serum levels of blood urea nitrogen （ BUN）, serum creatinine （ SCr）, N-terminal pro-B-type natriuretic peptide （ NT-proBNP）, IL- 1 and IL-6 were detected, microalbuminuria （MAU） was detected randomly, left ventricular ejection fraction （LVEF） was meas-ured by echocardiography, glomerular filtration rate （eGFR） was calculated. The levels of IL-1, IL-6, NT-proBNP, MAU and eGFR in different cardiac function groups were compared and the levels of IL-1 and IL-6 in different renal func- tion groups were compared. The relationship between IL-1, IL-6 and NYHA functional classification, NT-proBNP, LVEF, eGFR and MAU were analysed. Results The serum levels of IL-1, IL-6, NT-proBNP and MAU in NYHA Ⅲ -Ⅳ groups were higher than NYHA Ⅱ group （P〈0.05）, the eGFR of NYHA Ⅲ -Ⅳ groups were lower than NYHA Ⅱ group （P〈0.05）, and the levels of IL-1, IL-6, NT-proBNP and MAU in NYHA Ⅳ group were higher than NYHA Ⅲ group （P〈 0.05）. In NYHA functional class Ⅲ -Ⅳ patients the serum levels of IL-1, IL-6, NT-proBNP and MAU in 30%≤EF≤50% group were higher than EF〉50%group （P〈0.05）, the eGFR of 30% ≤EF≤50% group were lower than EF〉50% group （P〈0. 05）, the serum levels of IL-1, IL-6, NT-proBNP and MAU in EF〈30% group were higher than 30% ≤EF≤50% group （P〈0.05）. In NYHA functional class Ⅲ -Ⅳ patients the serum levels of IL-1, IL-6 in renal dysfunction group [ eGFR〈60 mL/（ min. 1.73m^2 ） ] were higher than normal renal function group [ eGFR≥ 60 mL/（ min. 1.73m^2 ） ] （ P〈 0. 05）. The serum levels of IL-1, IL-6 and eGFR had no obvious difference in different basic etiologies groups （P〉0. 05）. The serum levels of IL-1 and IL-6 were positively correlated with the NYHA functional classification, MAU and NT-proBNP （P〈0. 05）, negatively correlated with LVEF and eGFR （P〈0.05）. Conclusion The serum levels of IL-1 and IL-6 are elevated in patients with chronic heart failure and correlated with the severity of chronic heart failure and renal damage, and detecting IL-1, IL-6 may provide some assistances for assessing the severity of heart failure in clinical.