心力衰竭患者血红蛋白水平与神经内分泌细胞因子关系及对心室重构的影响  

Correlation of hemoglobin level with cytokines neurohormonal activity and their effects on ventricular remodeling in patients with congestive heart failure

作　　者：郗爱旗[1] 褚以德[1] 李英兰[1] 赵文蕊[1] 钟欣[1] 廖宝霞[1] 李国峰[1] 尚玲[1] 

机构地区：[1]青海省人民医院老年医学研究所,西宁市810007

出　　处：《中华老年医学杂志》2008年第7期494-497,共4页Chinese Journal of Geriatrics

基　　金：青海省科技厅自然科学基金项目（2006-N-149）

摘　　要：目的探讨慢性心力衰竭（CHF）患者血红蛋白（Hb）水平变化与神经内分泌激素、细胞因子和B型钠尿肽（BNP）的关系及对心室重构的影响。方法对入选的121例CHF患者测定Hb、血管紧张素Ⅱ（AngⅡ）、肿瘤坏死因子（TNF）-α、一氧化氮（N0）、细胞间黏附分子（ICAM）-1、BNP水平，超声心动图测量左室射血分数（LVEF），评价心功能，计算左心室质量指数（LVMI）和平均室壁应力（MWS）；CHF患者按Hb水平分为贫血组和非贫血组。同时选择27例健康人为对照组。结果CHF组患者AngⅡ、TNF-α、NO和ICAM1、BNP水平以及LVMI和MWS高于对照组（均为P〈0．01），而Hb水平和LVEF低于对照组；随着AngⅡ、TNF-α、NO、ICAM-1、BNP水平以及MWS和LVMI升高，Hb水平逐渐降低，心功能指标下降；CHF贫血组AngⅡ、TNF-α、NO、ICAM-1、BNP水平及MWS和LVMI高于非贫血组，分别[为（144．5±64．1）ng／L与（76．7±48．5）ng／L、（92．3±6．4）ng／L与（55．6±10．2）ng／L、（65．2±4．2）μmol／L与（42．1±11．9）μmol／L、（253．6±26．0）μg／L和（237．2±33．3）pg／L、（1294．0±223．0）ng／L与（437．0±115．0）ng／L、P〈0．01]；随着Angll、TNF-α、NO、ICAM-1、BNP水平以及MWS和LVMI进一步升高，CHF患者贫血程度加重；CHF患者Hb与AngⅡ、TNF-α、NO、ICAM-1、BNP水平及LVMI和MWS均呈负相关（r分别为-0．8173、-0．8509、-0．6001、-0．6692、-0．6283、-0．8604、-0．8733，P〈0．01）。结论CHF患者神经内分泌激素激活、细胞因子过度表达参与了心室重构和贫血发生发展的病理过程，而贫血使心室重构程度加重。Objective To study the relationships of hemoglobin（Hb） level with the levels of neurohormones, and cytokines, and the effect of them on ventricular remodeling in patients with congestive heart failure （CHF）. Methods Hb level, serum angiotensin Ⅱ （AngⅡ）, tumor necrosis factor-α（TNF-α）, nitric oxide （NO）, soluble intercellular adhesion molecule-1 （sICAM-1）and B type natriuretic peptide （BNP） were measured in 121 CHF patients. The left ventricular ejection fraction （LVEF） from echocardiography, left ventricular mass index （LVMI）, and mean wall stress （MWS） were calculated. Results The levels of AngⅡ ,TNF-α,NO, sICAM-1 ,BNP（（144.5±64. 1）ng/L, （92. 3±6.4）ng/L, （65.2±4.2）μmol/L, （253.6±26.0）μg/L, （1294.0±223.0）ng/L] and LVMI, MWS in the anemia group of CHF patients were higher than those in the non-anemia group[（76.7±48.5）ng/L,（55.6±10.2）ng/L, （42. 1±11.9）μmol/L, （237.18±33.26）μg/L, （437.0±115.0）ng/ L, all P〈0. 013. With the increase of anemia severity, the levels of Ang Ⅱ ,TNF-α,NO, sICAM-1, BNP and LVMI, MWS were significantly increased. There were negative correlations between Hb level and the levels of AngⅡ ,TNF-α,NO, sICAM-1, BNP,LVMI, MWS （r=-0. 8173,-0. 8509, -0. 6001 ,-0. 6692,-0. 6283,-0. 8604,-0. 8733,all P〈0.01）, and negative correlations between LVMI, MWS and Hb levels and LVEF （P〈0.01）. Conclusions Neurohormones and cytokines play roles in ventricular remodeling and anemia in CHF aggravates the severity of ventricular remodeling.

关 键 词：心力衰竭 充血性 血红蛋白类 肿瘤坏死因子Α 心室重构 

分 类 号：R686[医药卫生—骨科学]