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目的 观察慢性充血性心力衰竭 (CHF)患者血清瘦素 (LP)、肿瘤坏死因子 -α(TNFα)浓度的变化及其与胰岛素 (INS)等因素的关系。方法 测定 40例CHF患者的血清LP、TNFα、空腹胰岛素 (FINS)浓度、体重指数 (BMI)等指标 ,并与健康人作对照。LP、FINS用放免法测定 ,TNFα用ELISA法测定。结果 ⑴轻度心衰患者 (NYHA心功能分级Ⅰ、Ⅱ级 )的血清LP、FINS浓度与对照比较无显著性差异 (P >0 0 5 ) ;中、重度心衰患者 (NYHA心功能分级Ⅲ、Ⅳ级 )的血清LP、FINS浓度明显低于对照组 (P <0 0 5～0 0 5 )。⑵CHF患者的血清TNFα明显高于对照组 ,但与心功能分级无关。结论 ⑴CHF患者血清LP、FINS浓度与NYIIA心功能分级有关 ,轻度心衰患者体内存在合成代谢 ,而中、重度心衰患者体内以分解代谢为主。⑵CHF患者体内TNFα浓度升高 ,但与NYHA心功能分级无关。
Objective To investigate the changes of serum leptin (LP) and tumor necrosis factor-α (TNFα) in patients with chronic congestive heart failure (CHF) and their relationship with insulin (INS) and other factors. Methods The serum levels of LP, TNFα, FINS and BMI in 40 CHF patients were measured and compared with healthy controls. LP and FINS were determined by radioimmunoassay and TNFα by ELISA. Results (1) There was no significant difference in serum LP and FINS concentrations between mild heart failure patients (NYHA class Ⅰ and Ⅱ) and control group (P> 0.05), moderate and severe heart failure patients (NYHA class Ⅲ , Ⅳ) serum LP, FINS concentrations were significantly lower than the control group (P <0 05 ~ 0 0 5). ⑵ CHF patients serum TNFα was significantly higher than the control group, but nothing to do with the classification of cardiac function. Conclusions (1) Serum LP and FINS concentrations in CHF patients are related to NYIIA cardiac function classification. The patients with mild heart failure have anabolic metabolism in vivo, while the patients with moderate and severe heart failure are mainly catabolized in vivo. ⑵ CHF patients with elevated levels of TNFα, but NYHA functional class has nothing to do.