充血性心力衰竭炎性细胞因子的改变

Proinflammatory cytokines in patients with congestive heart failure

目的 :探讨充血性心力衰竭 (CHF)时肿瘤坏死因子 α(TNF α)、白细胞介素 6 (IL 6 )、白细胞介素 1β(IL 1β)和一氧化氮 (NO)的变化 ,及其与CHF关系。 方法 :CHF患者 4 5例和年龄匹配的对照者 17例 ,根据NY HA分级将CHF患者分成Ⅱ、Ⅲ、Ⅳ级 3组 ;根据体重分成恶病质组及非恶病质组。用酶联免疫法测定IL 6 ,用放射免疫法测定IL 1β、TNF α ,用比色法测定NO。 结果 :CHF组血清IL 6、IL 1β、TNF α和NO较对照组明显升高 ,IL 6、NO在心功能Ⅱ、Ⅲ、Ⅳ级时均显著升高 ,TNF α在Ⅲ、Ⅳ级时显著升高 ,而IL 1β在Ⅳ级时才显著升高。不同病因的CHF之间差异无统计学意义 ,恶病质组及非恶病质组之间差异也无统计学意义。血清TNF α与IL 6呈正相关 (r =0 .5 82 9,P <0 .0 1)。结论 :血清IL 6、IL 1β、TNF α、NO水平与CHF的严重程度密切相关 ,可作为判断CHF严重程度的指标 ;IL 6、IL 1β、TNF

Objective:To study the change of the serum level of proinflammatory cytokines(PIC): tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), interleukin-1β (IL-1β) and nitric oxide(NO), and to assess their effects on congestive heart failure and their relationship between each other.Method:IL-6 was measured by enzyme-linked immunosorbent assay,and TNF-α, IL-1β by radioimmuno assay, NO by colorimetry in 45 patients with various degrees of CHF and 17 age-matched control subjects. The patients were devided into 3 groups(cardiac function classⅡ, Ⅲ, Ⅳ,according to NYHA classficiation), and divided into “cachectic” and “noncachectic” groups based on body weight patients with CHF were identified as “cachexia” when their body weight was less than 85 percent of ideal body weight.Result:The levels of above serum analytes were significantly elevated in patients with CHF as compared with control subjects. NO, IL-6 were obviously risen in patients with cardiac function class(NYHA)Ⅱ、Ⅲ、Ⅳ, and TNF-α rose in ones with NYHA class Ⅲ and Ⅳ, but IL-1β only rose in ones with class Ⅳ. There were no significant difference between various etiology CHF groups and between “cachectic” and “noncachectic” groups.Serum TNF-α was positively related with serum IL-6(r= 0.5829,P< 0.01).Conclusion:The level of serum IL-6, IL-1β, TNF-α, NO are closely related with severity of CHF, and can serve as the markers to judge the severity and the prognosis of CHF. IL-6, IL-1β and TNF-α may play an important role in the incidence and progress of heart failure.