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背景:充血性心力衰竭血清中一些细胞因子如白细胞介素6和肿瘤坏死因子α以及神经激素如去甲肾上腺素对于心力衰竭发生发展过程中是否起到重要作用。目的:探讨心力衰竭患者血清肿瘤坏死因子α、白细胞介素6,去甲肾上腺素的变化及意义,为判定心力衰竭严重程度及预后提供依据。设计:病例对照研究。单位:上海市市东医院心内科。方法:选择2000-01/2001-10上海市市东医院心内科住院心力衰竭患者58例(患者组),男33例,女25例。按纽约心脏病学会心功能分级,其中Ⅱ级12例,Ⅲ级32例,Ⅳ级14例。选择同期本院自愿健康体检者30例为对照组,男18例,女12例。采用酶联免疫双抗体夹心法测定血清肿瘤坏死因子α,白细胞介素6,去甲肾上腺素水平,用二维心脏超声测定左室射血分数,以此来观察血清细胞因子与心功能之间的关系。结果:①心功能Ⅲ级,Ⅳ级患者血清白细胞介素6[(367.6±78.6),(569.7±117.3)ng/L],肿瘤坏死因子α[(395.3±82.4),(583.1±124.8)ng/L],NE[(396.5±85.3),(675.9±136.2)ng/L]水平明显高于心功能Ⅱ级和对照组[(221.5±58.4),(170.2±42.7)ng/L;(205.4±59.2),(180.3±43.8)ng/L;(227.4±65.6),(163.8±41.5)ng/L,P均<0.05]。心功能Ⅱ级患者与对照组比较,差异无显著性意义(P>0.05)。②白细胞介素6,肿瘤坏死因子α,去甲肾上腺素与左室射血分数呈高度负相关(r=-0.63,P<0.01;r=-0.54,P<0.05;r=-0.58,P<0.01)。心力竭衰程度越重,血清肿瘤坏死因子α,白细胞介素6和去甲肾上腺素水平越高。肿瘤坏死因子α与去甲肾上腺素,白细胞介素6与去甲肾上腺素呈明显正相关(r=0.57,P<0.01;r=0.51,P<0.05)。心力衰竭患者心力衰竭越重,血清白细胞介素6与肿瘤坏死因子α水平越高,且两者呈正相关(r=0.39,P<0.05)。结论:心力衰竭患者血清肿瘤坏死因子α和白细胞介素6水平均升高,尤其在中重度心力衰竭患者中更加明显,并与左室射血分数呈负相关,提示血清白细胞介素6、肿瘤坏死因子α水平可作为心力衰竭严重程度判断与预后的指标,并为康复干预措施介入提供量化评估依据。
BACKGROUND: Some cytokines, such as interleukin-6 and tumor necrosis factor-α, in serum of congestive heart failure and neurohormones such as norepinephrine play an important role in the development of heart failure. Objective: To investigate the changes and significance of serum tumor necrosis factor-α, interleukin-6 and norepinephrine in patients with heart failure and provide the basis for judging the severity and prognosis of heart failure. Design: Case-control study. Unit: Shanghai East Hospital Cardiology. Methods: A total of 58 patients (patient group), including 33 males and 25 females, were selected as the inpatients with heart failure in Department of Cardiology, Shanghai East Hospital from January 2000 to October 2001. According to the New York Heart Association Society of Cardiac Function Classification, of which 12 cases of grade Ⅱ, Ⅲ grade 32 cases, Ⅳ grade 14 cases. Select the same period our hospital voluntary health examination of 30 patients as control group, 18 males and 12 females. Serum levels of TNF-α, IL-6 and norepinephrine were measured by enzyme-linked immunosorbent assay (ELISA), and left ventricular ejection fraction was measured by two-dimensional echocardiography to observe the relationship between serum cytokines and cardiac function Relationship. Results: ① The levels of serum interleukin 6 [(367.6 ± 78.6), (569.7 ± 117.3) ng / L], tumor necrosis factor α (395.3 ± 82.4), (583.1 ± 124.8) ng (221.5 ± 58.4) and (170.2 ± 42.7) ng / L, respectively; (205.4 ± 0.53), (675.9 ± 136.2) ng / L, ± 59.2), (180.3 ± 43.8) ng / L, (227.4 ± 65.6) and (163.8 ± 41.5) ng / L respectively, P <0.05]. Compared with the control group, there was no significant difference in cardiac function grade Ⅱ patients (P> 0.05). ② The levels of interleukin 6, tumor necrosis factor α, norepinephrine and left ventricular ejection fraction were highly negative correlation (r = -0.63, P <0.01; r = -0.54, P <0.05; r = -0.58, P <0.01). The more severely weary heart failure, the higher the levels of serum tumor necrosis factor alpha, interleukin 6 and norepinephrine. Tumor necrosis factor alpha and norepinephrine, interleukin 6 and norepinephrine were positively correlated (r = 0.57, P <0.01; r = 0.51, P <0.05). Heart failure patients with heart failure more severe, serum interleukin 6 and tumor necrosis factor alpha levels higher, and the two was positively correlated (r = 0.39, P <0.05). CONCLUSIONS: The levels of serum tumor necrosis factor-α and interleukin-6 in patients with heart failure are elevated, especially in patients with moderate-severe heart failure, and negatively correlated with left ventricular ejection fraction, suggesting that serum interleukin-6, tumor The level of necrosis factor alpha can be used as an indicator of the severity of heart failure and prognosis, and provide a quantitative basis for the intervention of rehabilitation interventions.