慢性充血性心力衰竭患者血浆中C-反应蛋白、肾上腺髓质素及内皮素水平变化的研究

目的 :以血浆 C-反应蛋白 ( CRP)的浓度作为体内细胞因子激活程度的指标 ,研究心力衰竭时细胞因子激活后 CRP的变化及对肾上腺髓质素 ( ADM)及内皮素 - 1( ET- 1)等血管活性物质的影响。　　方法 :CRP采用散射比浊法测定 ,ET- 1及 ADM采用放射免疫分析法测定。对 3 0例失代偿性心功能衰竭患者 (为心力衰竭组 )及 2 5例心功能正常的原发性高血压患者 (为心功能代偿组 )血浆 CRP、ADM及 ET- 1的浓度进行测定。　　结果 :心力衰竭组血浆 CRP、ADM及 ET- 1浓度较心功能代偿组均明显升高 ;在心力衰竭组 ,不同心功能 ( NYHA)分级的患者随心功能衰竭加重 ,血浆 CRP及 ADM的浓度均有所升高 ,而 ET- 1浓度在不同心功能分级的患者中无显著差异 ;心力衰竭组患者血浆 CRP浓度及 ADM浓度呈正相关。　　结论 :慢性充血性心力衰竭患者体内存在着细胞因子、ADM及 ET- 1的激活 ,细胞因子活化可能通过促进 ADM等的合成作用于心力衰竭的体液调节 ,但与 ET- 1的活化没有明显的关系。

The Changes of the Levels of C-Reactive Protein,Adrenomedullin and Endothelin-1 in Patients of Chronic Congestive Heart Failure

Objectives:To assess the degree of cytokine activation in patients with chronic congestive heart failure (CHF) as indicated by plasma levels of c reactive protein (CRP) and investigate its relation to adrenomedullin (ADM) and endothelin 1 (ET 1). Methods:The plasma levels of CRP,ADM and ET 1 of 30 decompensated heart failure (DHF) patients group and 25 essential hypertension patients with compensated cardiac function (CCF) group were tested CRP by immunoturbidometry,ET 1 and ADM by radio immunoassay. Results:The plasma levels of ET 1,ADM and CRP of decompensated heart failure group were significantly higher than the compensated cardiac function group;In the decompensated heart failure group,the plasma levels of CRP and ADM were elevated according with the worsening of heart failure (NYHA Classification);In the decompensated heart failure group,the plasma levels of CRP were positively correlated with ADM( r =0 57). Conclusion:There is extensive activation of cytokines,ADM and ET 1 in patients with chronic congestive heart failure.Cytokine activation might play a role in the synthesis of ADM,thus contributing to the humoral regulation of heart failure,but may not be responsible for the activation of ET 1.