心力衰竭患者血浆细胞因子的变化及其临床意义

The changes and importance of plasma cytokines in patients with congestive heart failure

目的 探讨充血性心力衰竭 (心衰 ,CHF)患者血中肿瘤坏死因子 α(TNF α)和白细胞介素 6(IL 6)的变化及其临床意义。方法 双抗体夹心ELISA法测定 12 2例CHF患者及 3 0例健康人血浆中TNF α和IL 6的浓度。超声心动图测量左心室射血分数及左心室舒张末期内径 ,X线胸片测心胸比。结果 CHF患者血浆中TNF α水平明显高于对照组 (P <0 .0 5 ) ,且随着心衰程度的加重 ,TNF α水平呈进行性增高 ;IL 6水平仅在心功能Ⅲ级、Ⅳ级组中明显高于对照组 (P <0 .0 5 )。TNF α、IL 6与左心室射血分数呈负相关 (r =-0 .5 13 ,r =-0 .45 3 ,P <0 .0 1) ,与心胸比呈正相关 (r =0 .5 0 1,r =0 .43 8,P <0 .0 1) ;与左心室舒张末期内径呈正相关 (r =0 .3 42 ,r =0 .3 0 4,P<0 .0 1)。结论 CHF患者TNF α和IL 6升高可能是心功能恶化的免疫学标志之一 。

Objective To explore the changes and importance of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)in patients with congestive heart failure(CHF).Methods The plasma levels of TNF-α,IL-6 were examined by ELISA in 122 cases with CHF and 30 normal controls.The left ventricular ejective fraction(LVEF),left ventricular end-diastolic diameter(LVEDd)were examined by echocardiography.The heart thorax ratios(HTR)were measured by chest X-ray.Results Plasma levels of TNF-α were increased in CHF compared with controls(P<0.05 or 0.01).The more severer CHF,the more higher plasma TNF-α levels.IL-6 levels were elevated just in NYHA function class Ⅲ and Ⅳ compared with controls(P<0.05 or 0.01).TNF-α,IL-6 were negatively correlated with LVEF(r=-0.513,r= -0.453,P<0.01),positively correlated with(r=0.501,r=0.438,P<0.01)HTR and LVEDd(r= 0.342,r=0.304,P<0.01).Conclusion The elevated plasma levels of TNF-α and IL-6 may be an immunologic mark of the severity of CHF.In conclusion,the inflammatory mechanism may be related to the progression of CHF.