静息心率与慢性心力衰竭患者炎症因子及血脑钠肽的关系

Association of resting heart rate with inflammatory factors and brain natriuretic peptide concentration in patients with chronic heart failure

目的探讨慢性心力衰竭(CHF)患者入院时静息心率与炎症因子及血脑钠肽(BNP)的关系。方法选择2015年1月至2016年6月在上海市浦东医院心血管内科住院的180例纽约心脏学会(NYHA)心功能分级Ⅱ~Ⅳ级的CHF患者,按静息心率将患者分为A组(心率≤70次/min)56例,B组(心率:70~90次/min)76例,C组(心率>90次/min)48例;患者入院时检测炎症因子C-反应蛋白(CRP)、白介素-1β(IL-1β)、白介素-6(IL-6)、肿瘤坏死因子α(TNF-α),血浆BNP水平以及左室射血分数(LVEF),比较各组患者相关指标的差异。结果三组患者在炎症因子、血清BNP水平及LVEF方面比较差异均有显著统计学意义(P<0.01);C组患者与A组和B组的CRP[(8.52±0.49)mg/L vs(5.87±0.46)mg/L vs(6.94±0.57)mg/L]、IL-1β[(29.2±3.3)pg/m L vs(16.6±2.7)pg/m L vs(22.7±2.9)pg/m L]、IL-6[(109.6±11.8)ng/L vs(80.2±9.8)ng/L vs(97.8±12.4)ng/L]、TNF-α[(65.8±12.9)ng/m L vs(33.6±6.8)ng/m L vs(45.8±8.1)ng/m L]及BNP[(962±106.4)pg/m L vs(595±68.9)pg/m L vs(726±98.3)pg/m L]水平比较,C组明显高于A组和B组,而LVEF[(38.1±6.8)%vs(49.2±5.9)%vs(43.6±5.6)%比较,C组明显低于A组和B组,差异均有统计学意义(P<0.05);与A组比较,B组患者的CRP、IL-1β、IL-6、TNF-α及BNP水平明显增高,LVEF明显偏低,差异均有统计学意义(P<0.05);Pearson相关分析显示,所有CHF患者的静息心率与CRP、IL-1β、IL-6、TNF-α及BNP呈正相关(r分别为0.305、0.297、0.319、0.331和0.562,P<0.05),与LVEF呈负相关(r=-0.345,P<0.05)。结论静息心率水平与慢性心力衰竭患者炎症因子及BNP水平呈正相关,与LVEF呈负相关。

Objective To evaluate the relationships of resting heart rate with inflammatory factors and brain natriuretic peptide（BNP） concentration in patients with chronic heart failure（CHF）. Methods From January 2015 to June 2016, A total of 180 CHF patients in New York Heart Association（NYHA） functional class Ⅱ-Ⅳ, who admitted to Department of Cardiology of Shanghai Pudong Hospital, were enrolled and divided into the group A（≤70 beats/min, n=56）, group B（70-90 beats/min, n=76） and group C（90 beats/min, n=48） according to resting heart rates. The concentration of C-reaction protein（CRP）, interleukin-1β（IL-1β）, interleukin-6（IL-6）, tumor necrosis factor α（TNF-α）, BNP,left ventricular ejection fracetion（LVEF） at admission were measured and compared. Results There were significant differences between the three groups in inflammatory factors, serum BNP level and LVEF. The levels of CRP, IL-1β, IL-6, TNF-α, and BNP in the group C were（8.52±0.49） mg/L,（29.2±3.3） pg/m L,（109.6±11.8） ng/L,（65.8±12.9） ng/m L,（962±106.4）pg/m L, respectively, which were significantly higher than（5.87±0.46） mg/L,（16.6±2.7） pg/m L,（80.2±9.8） ng/L,（33.6±6.8） ng/m L,（595±68.9） pg/m L in the group A and（6.94±0.57） mg/L,（22.7±2.9） pg/m L,（97.8±12.4） ng/L],（45.8±8.1）ng/m L,（726±98.3） pg/m L in the group B（P0.01）. While, the LVEF in the group C was（38.1±6.8）%, which was significantly lower than（49.2±5.9）% in the group A and（43.6±5.6）% in the group B（P0.01）. Compared with the group A, the levels of CRP, IL-1β, IL-6, TNF-α and BNP were significantly increased, but LVEF was significantly decreased（P0.05）. Pearson＇s correlation analysis revealed that resting heart rate had positive correlation with CRP（r=0.305, P0.05）,IL-1β（r=0.297, P0.05）, IL-6（r=0.319, P0.05）, TNF-α（r=0.331, P0.05） and BNP levels（r=0.562, P0.05）, and negative correlation with LVEF（r=-0.345, P0.05）. Conclusion In the patients with CHF, resting heart rate is positively correlated with inflammatory factors and BNP levels, and negatively correlated with LVEF.