氨甲喋呤对充血性心力衰竭患者的非特异抗炎作用  

The nonspecific anti-inflammatory effect of methotrexate in patients with congestive heart failure

作　　者：龚开政[1] 张振刚[2] 李爱华[1] 孙晓宁[1] 严俊峰[1] 骆秋平[1] 高阳[1] 张昕[1] 凤以良[1] 

机构地区：[1]扬州市第一人民医院心内科东南大学扬州心血管病研究所,江苏扬州225001 [2]扬州大学医学院

出　　处：《临床心血管病杂志》2005年第2期93-96,共4页Journal of Clinical Cardiology

摘　　要：目的:评价小剂量氨甲喋呤(MTX)对充血性心力衰竭(CHF)患者血浆中各炎症递质的调节作用及其临床意义.方法:62例CHF患者(NYHA Ⅱ～Ⅳ)被随机分为MTX治疗组(7.5 mg/周)和常规治疗组,共治疗12周,观察两组患者血浆中各炎症递质表达水平及临床病情,并与正常对照组比较.结果:①CHF患者外周血浆中各炎症递质水平均显著高于正常对照组;②MTX治疗组患者血浆中肿瘤坏死因子-α和单核细胞趋化蛋白-1的水平显著低于常规治疗组[(2.81 ±0.83) μg/L ∶(3.23 ±0.89)μg/L;(49.9 ±20.9)ng/L∶(60.4 ±17.7)ng/L,均P<0.05),而可溶性白细胞介素-1受体拮抗剂的水平高于常规治疗组[(92.7 ±22.0)ng/L ∶(78.2 ±15.5)ng/L,P<0.05].③与常规治疗组比较,MTX治疗组在心功能分级、生活质量、运动耐量方面可得到进一步改善,但CHF患者两组在左室射血分数及左室舒张末期直径以及重要的心血管不良事件发生率差异无统计学意义.结论:小剂量MTX治疗对CHF患者具有非特异性的免疫调节作用.Objective:To evaluate the effects of low dose methotrexate (MTX) on the plasma levels of inflammatory mediators in patients with congestive heart failure (CHF). Method:Sixty-two patients with common treatment were randomized to MTX ( 7.5 mg/week) group or placebo group with follow-up for 12 weeks. The changes of plasma levels of some inflammatory mediators,LVEF,LVEDD,NYHA classification,exercise capacity and quality of life in patients with CHF were observed. Result:①The plasma levels of inflammatory mediators in patients with CHF were markedly elevated compared to healthy control. ②The plasma levels of tumor necrosis factor-alpha and monocyte chemoattractant peptide-1 in MTX group were markedly decreased than those in placebo group ( 2.81 ± 0.83 μg/L vs ( 3.23 ± 0.89)μg/L, ( 49.9± 20.9)ng/L vs ( 60.4± 17.7)ng/L,all P< 0.05]. The plasma level of soluble interleukin-1 receptor antagonist in MTX group was decreased compared to placebo group 12 weeks later [( 92.7± 22.0)ng/L vs ( 78.2 ± 15.5)ng/L, P< 0.05]. ③The NYHA classification, exercise capacity and quality of life in MTX group got further improved compared to placebo group. But the LVEF, LVEDD and the incidence of main cardiovascular events in MTX group and placebo group were not different at the end of study. Conclusion:The results suggest that methotrexate treatment in CHF is associated with a nonspecific immunomodulatory effects.

关 键 词：心力衰竭 充血性 氨甲喋呤 免疫调节 细胞因子 

分 类 号：R541.6[医药卫生—心血管疾病]