左心室射血分数正常的慢性心力衰竭患者血清脂联素、肿瘤坏死因子-α的变化及临床意义

Changes and clinical significance of serum adiponectin and TNF-α in patients with chronic heart failure and preserved left-ventricular ejection fraction

目的探讨左心室射血分数(LVEF)正常的慢性心力衰竭(CHF)患者血清脂联素、肿瘤坏死因子-α(TNF-α)的变化及临床意义,以期为临床上CHF患者病情程度、判断预后提供参考。方法选取西安市第九医院心内科2018年1月至2019年2月间收治的82例左心室射血分数正常的CHF患者作为研究对象,根据心功能NYHA分级进行分组,其中Ⅱ级30例,Ⅲ级28例,Ⅳ级24例。比较三组受检者血清N末端B型钠尿肽前体(NT-proBNP)、TNF-α及脂联素水平,以及心超指标LVEF、左室舒张末期内径(LVEDd),分析TNF-α及脂联素与NT-proBNP、LVEF、LVEDd的相关性。结果随着NYHA心功能分级水平的增高,血清NT-pro BNP、TNF-α及脂联素水平逐渐增高,LVEDd逐级增加,而LVEF逐渐降低,差异均有统计学意义(P<0.05);血清TNF-α、脂联素水平与NT-proBNP均呈正相关性(r=0.542、0.492,P<0.05);血清TNF-α、脂联素与LVEDd呈正相关(r=-0.602、0.523,P<0.05),与LVEF呈负相关(r=-0.735、-0.647,P<0.05)。结论血清脂联素、TNF-α水平与LVEF正常的CHF患者的病情严重程度密切相关;检测其水平对评估患者的病情程度、判断预后有一定的临床参考价值。

Objective To investigate the changes and clinical significance of serum adiponectin and tumor necrosis factor-alpha(TNF-alpha)in patients with chronic heart failure(CHF)and normal left ventricular ejection fraction(LVEF),in order to provide some help for clinical CHF patients to judge the degree of disease and prognosis.Methods A total of 82 CHF patients with chronic heart failure and preserved left-ventricular ejection fraction,who treated in the Ninth Hospital of Xi'an from January 2018 to February 2019,were selected as the study subjects.The patients were grouped according to NYHA classification of cardiac function,including 30 cases of gradeⅡ,28 cases of gradeⅢand 24 cases of gradeⅣ.The serum levels of NT-proBNP,TNF-αand adiponectin,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDd)were compared among the three groups.The correlation between TNF-αand adiponectin and NT-proBNP,LVEF and LVEDd was analyzed.Results The serum levels of NT-pro BNP,TNF-αand adiponectin increased,LVEDd increased,and LVEF decreased with the increase of NYHA cardiac function grade(P<0.05);the serum levels of TNF-αand adiponectin were positively correlated with NT-proBNP(r=0.542,0.492,P<0.05);the serum levels of TNF-αand adiponectin were positively correlated with LVEDd(r=-0.602,0.523,P<0.05).It was negatively correlated with LVEF(r=-0.735,-0.647,P<0.05).Conclusion The levels of serum adiponectin and TNF-alpha are closely related to the severity of CHF patients with normal LVEF.Detecting the levels of adiponectin and TNF-alpha has certain clinical reference value for evaluating the severity of CHF patient's condition and judging the prognosis.