慢性充血性心力衰竭患者细胞因子变化与其心功能状态的关系  

Relationship between cytokine changes and cardiac status in patients with chronic congestive heart failure

作　　者：黄榕翀[1] 杨春[2] 谷玲[2] 李晶[2] 路岩[1] 姜一农[1] 

机构地区：[1]大连医科大学附属第一医院心内科,辽宁省大连市116011 [2]大连医科大学附属第一医院核医学科,辽宁省大连市116011

出　　处：《中国临床康复》2005年第11期52-53,共2页Chinese Journal of Clinical Rehabilitation

摘　　要：目的:研究慢性充血性心力衰竭(chroniccongestiveheartfailure,CHF)患者血清中肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和C反应蛋白(C-reactiveprotein,CRP)的变化及各指标间相关性,以期发现上述因子与CHF病情发展的关系。方法:选择2001-01/2002-03在大连医科大学附属第一医院心内科一病房、二病房住院并符合纳入标准的NYHA心功能Ⅱ～Ⅳ级CHF患者176例和同期在本院进行健康体检者30例对照组为研究对象。()176例CHF患者心功能Ⅱ级60例,Ⅲ级86例,Ⅳ级30例。测定研究对象血清中TNF-α,IL-6和CRP水平。比较分析CHF患者与正常人以及不同心功能程度的CHF患者之间各细胞因子的变化,以及TNF-α,IL-6和CRP的相关性。结果:心功能Ⅱ级CHF患者血清中TNF-α,IL-6和CRP水平与对照组比较,差异无显著性意义(P>0.05);心功能Ⅲ级以上CHF患者血清中TNF-α,IL-6和CRP水平明显高于正常对照组(P<0.01),且心功能Ⅱ级与Ⅲ级、Ⅱ级与Ⅳ级、Ⅲ级与Ⅳ级间各因子水平比较,差异均有显著性意义(P<0.01)。随着心力衰竭程度的加重而增高,血清CRP水平与IL-6,TNF-α呈高度正相关(r=0.62,0.57,P<0.01)。血清IL-6与TNF-α水平呈正相关(r=0.42,P<0.05)。结论:心力衰竭患者存在免疫激活和心肌炎症反应,心力衰竭程度越重,炎症反应也越明显。AIM:To investigate the changes of serum tumor necrosis factor alpha(TNF α ),interleukin 6(IL 6) and C reactive protein(CRP) in patients with chronic congestive heart failure(CHF) and the correlation among them, so as to find out the association between the above indexes and the progress of CHF. METHODS:Totally 176 CHF inpatients with New York Heart Association(NYHA) classification of grade Ⅱ to Ⅳ ,who were hospitalized in the No.1 and 2 sickrooms of cardiological department of the First Affiliated Hospital of Dalian Medical University from January 2001 to March 2003,and 30 healthy physical examinees(control group) in this hospital at the same time were involved in the study.Serum levels of TNF α ,IL 6 and CRP were measured in all the subjects.The changes and the relationship among serum TNF α ,IL 6 and CRP were compared and analyzed between CHF patients and normal controls,also among the CHF patients with different levels of cardiac function. RESULTS:There were insignificant differences in the serum levels of TNF α ,IL 6 and CRP between CHF patients with cardiac function of grade Ⅱ and control group(P >0.05).The serum levels of TNF α ,IL 6 and CRP were significantly higher in the CHF patients with cardiac function above grade Ⅲ than in the control group(P< 0.05),and there were significant differences between the CHF patients with cardiac function of grade Ⅱ and Ⅲ ,grade Ⅱ and Ⅳ ,grade Ⅲ and Ⅳ (P< 0.01).The serum levels of TNF α ,IL 6 and CRP were increased with the severity of CHF,and the serum level of CRP had highly positive correlation with the IL 6 and TNF α levels (r=0.62,r=0.57,P< 0.01).Serum IL 6 level was positively correlated with that of TNF α (r=0.42,P< 0.05). CONCLUSION:Immunological activation and myocardial inflammation exist in CHF patients.The more severe CHF is, the more notable inflammation will be,and it is correlated with the cardiac status.

关 键 词：心力衰竭 充血性/血液 肿瘤坏死因子/血液 白细胞介素6/血液 C反应蛋白/血液 

分 类 号：R54[医药卫生—心血管疾病]