充血性心力衰竭患者血浆胰岛素水平与细胞因子含量的关系研究

Research on serum insulin and cytokine levels in patients with congestive heart failure

目的 探讨充血性心力衰竭 (CHF)患者是否存在高胰岛素血症、胰岛素抵抗 (IR)及与TNF -α、IL - 1β、IL - 6的关系。方法 通过放射免疫分析法分别测定心衰组 5 0例和对照组 4 6例的空腹血浆胰岛素 (FIS)、TNF -α、IL - 1β、IL - 6的水平 ,并计算空腹血糖和胰岛素乘积的倒数即胰岛素敏感性指数 (IAI) ,以评估心衰患者IR的严重程度并分析各参数之间的相关性。结果 心衰组与对照组的IAI分别为 - 1 5 1± 0 14和 - 1 87± 0 2 4 ,两者差异显著 (P <0 0 1)。慢性心衰组按病因重新分组后各组IAI相比无显著差异性 (P >0 0 5 )。直线相关回归分析表明 ,IAI与NYHA心功能分级和TNF -α分别存在相关性 ,直线关系r分别为 0 82和 - 0 73,差异有显著性 (P <0 0 1)。结论 心衰患者存在IR ,且与原发病因无关。IR的程度与NYHA心功能分级和TNF -α的水平有显著相关性。心功能越差 ,IR的程度越重 ,且心衰时IR与TNF -α的升高有关 ,提示IAI可作为心衰患者病情严重程度的预测指标。

Objective To explore the relation of serum insulin levels and cytokine levels in patients with congestive heart failure.Methods Respectively,fasting serum insulin,TNF-α,IL-1β and IL-6 were measured in acute heart failure (CHF) group(50 cases) and control group(46 cases) by radioimmunoassay (RIA) and assessed the degree of IR by calculating IAI(IAI=1/FBG×FIS) and assayed the relations between these indices.Results IAI between CHF group(-1.51±0.14) and control group (-1.87±0.24) was significantly difference(P<0 05) respectively, but there was no significantly difference for IAI among the different heart failure pathogenesis groups.IAI were significantly correlated with TNF-α and NYHA class respectively,and 'r' was-0.73 and 0.82 (P<0.05).Conclusions Insulin resistance (IR) and hyperinsulinaemia was a state of CHF and had no relation with pathogenesis of CHF. The degree of IR was significantly correlated with TNF-α and NYHA class, it might be helpful to indicate the severity of CHF and its therapeutic effect.