甲状腺激素水平与充血性心力衰竭的相关性以及小剂量甲状腺素的干预作用

目的:探讨甲状腺激素水平与充血性心力衰竭(CHF)的相关性,观察小剂量甲状腺素治疗CHF的效果。方法:采用放射免疫法测定68例充血性心力衰竭患者(CHF组)及50例健康对照者(对照组)的血清三碘甲腺原氨酸(T3)、游离三碘甲腺原氨酸(FT3)、甲状腺素(T4)、游离甲状腺素(FT4)和促甲状腺激素(TSH)水平,并进行比较。然后将甲状腺素水平降低的52例CHF患者分为观察组和治疗组,分别给予常规抗心衰治疗和常规抗心衰治疗+小剂量甲状腺素治疗,比较两组患者治疗前后心功能变化情况。结果:CHF组与对照组相比,T3、FT3水平明显降低(P0.05),且心力衰竭程度越重,T3、FT3水平降低越明显(P0.05),T4、FT4、TSH水平无显著性差异(P0.05)。CHF治疗组心功能改善明显优于CHF观察组(P0.05)。结论:CHF患者常伴有血清甲状腺素水平下降,且甲状腺素水平降低与心衰程度密切相关。短程小剂量甲状腺素治疗CHF安全、有效。     

Involvement of circulating interleukin-6 and its receptor in the development of euthyroid sick syndrome in patients with acute myocardial infarction

OBJECTIVE: In patients with acute myocardial infarction (AMI), low triiodothyronine (T(3)) levels with normal or subnormal levels of thyrotropin (TSH), the euthyroid sick syndrome (ESS), have been reported, however, the mechanism of altered thyroid hormone metabolism is unknown. Recent reports have shown that interleukin-6 (IL-6) plays a key role in the pathogenesis of AMI and ESS. This preliminary study investigates the relationship between thyroid states and plasma levels of IL-6, the soluble IL-6 receptor (sIL-6R), and the soluble transducing 130kDa glycoprotein (sgp130) in AMI. DESIGN AND METHODS: We measured the concentration of TSH, free T(3) (FT(3)), free thyroxine (FT(4)), IL-6, sIL-6R and sgp130 in plasma from 24 patients with AMI and 20 normal controls. RESULTS: All 24 AMI patients showed significantly lower concentrations of FT(3) with normal or subnormal levels of TSH, and higher concentrations of IL-6 and sIL-6R than controls. IL-6 level was correlated with creatine phosphokinase (CPK) and FT(3) levels but not with FT(4 )or TSH levels in patients with AMI. The time course of IL-6 and FT(3 )concentration seemed to be closely linked. sIL-6R level was correlated with CPK and sgp130 levels, but not with FT(3), FT(4) or TSH levels. FT(4 )level was correlated with sgp130 level. CONCLUSION: Patients with AMI develop ESS through activation of IL-6 and its receptor system.     

心力衰竭病人血甲状腺激素、促甲状腺素的测定及其意义

目的:探讨充血性心力衰竭(CHF)病人血清游离甲状腺激素(FT3、FT4)、促甲状腺激素(TSH)浓度的变化及其意义。方法:用放免法测定77例CHF病人及30例正常人血清FT3、FT4、TSH的浓度,并对11例Ⅲ或Ⅳ级CHF病人治疗前、后及各种原发病致CHF时的FT3、FT4、TSH浓度进行比较。结果:CHF组FT3降低(P<0.01),FT4及TSH正常。严重CHF可伴有FT4降低(P<0.01)。心衰越重,FT3降低越明显(P<0.05)。结论:FT3、FT4可作为CHF病情程度判断的一个指标。     

小剂量左旋甲状腺素对伴低T3综合征的慢性充血性心力衰竭患者心功能的影响

目的：评估小剂量补充左旋甲状腺素对伴低T3综合征的慢性充血性心力衰竭（CHF）患者的影响。方法：选择2010年1月至2012年1月在我院心内科住院确诊伴低T3综合征的CHF患者100例,随机平均分为2组：对照组常规抗心力衰竭药物治疗;治疗组在常规抗心力衰竭药物基础上每目口服1次左旋甲状腺素钠片25μg。随访期6个月,所有研究对象在研究初始及随访结束时均行甲状腺功能包括游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素释放激素（TSH）、甲状腺彩超、B型利钠肽（BNP）、基质金属蛋白酶（MMP）-9水平及左室质量指数（LVMI）检测,并记录两组患者心血管事件及不良反应的发生率。结果：与对照组比较,治疗组BNP、MMP-9水平明显降低,FT3水平升高（P〈0．05）。治疗组患者LVMI及心血管事件发生率较对照组无显著性差异;治疗组无明显不良反应发生。结论：对CHF伴低T3综合征的患者,加用小剂量左旋甲状腺素钠治疗,无明显不良反应,并可明显降低患者血清BNP及MMP-9水平。     

慢性心力衰竭患者血清三碘甲状腺原氨酸水平与脑利钠肽关系探讨

目的探讨慢性心力衰竭（CHF）患者血清三碘甲状腺原氨酸（T3）水平与脑利钠肽（BNP）的关系。方法测定114例慢性心力衰竭患者测定血清T3和BNP浓度。其中伴低T3血症的慢性心力衰竭患者60例（低T3组）和正常血T3的慢性心衰患者54例（正常T3组），观察两组BNP水平及6月内的再住院率。结果低T3组的心衰患者血清BNP水平均较正常T3组相同心功能级别者显著升高。低血T3组与正常血T3组心功能Ⅱ级、Ⅲ级、Ⅳ级的比较，BNP（pg/ml）分别为：280．4±80．2vs150±55．6，380±113．2vs300±63．5，570±133．3VS450．2±100．9，P〈0．01，低T3组再住院率高。结论慢性心衰伴低T3患者，血清BNP升高更明显，再住院率高。     

Change in serum thyroid hormone levels in patients with acute myocardial infarction

It has been reported that there is a decrease in the serum concentration of thyroid hormones in non-thyroidal illness. In the present study we made serial measurements of serum concentration of thyroid hormones [triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4), reverse triiodothyronine (rT3)], thyroid stimulating hormone (TSH) and thyroxine binding globulin (TBG) in 10 patients with acute myocardial infarction (AMI, Grade I, according to the classification of Killip & Forrester) during 14 days after onset. In the early phase of AMI, serum T3, T4, FT3 and FT4 levels decreased while rT3 increased. TSH and TBG levels, however, were unchanged. In the patients with a high peak creatine phosphokinase activity (greater than or equal to 400 mU/ml), the decrease in thyroid hormone and increase in serum rT3 levels were greater than in patients with a low peak value (less than 400 mU/ml), suggesting a correlation between severity of AMI and changes in serum thyroid hormone levels. Especially, serum FT3 levels fell below the lower limit of controls within 14 days, with the lowest levels and the rT3 peak on the third day after onset. These data suggest that in AMI peripheral conversion of T4 favours rT3 production and that low levels of serum FT3 and T3 protect the infarcted heart muscle against thyroid hormone action.     

老年充血性心力衰竭患者心功能与甲状腺激素的关系

目的 探讨血清N末端B型脑钠肽前体（NT-proBNP）和甲状腺激素的关系,以及在老年充血性心力衰竭患者治疗中的临床价值.方法 测定老年慢性充血性心力衰竭（CHF）患者不同心功能状态下血清NT-proBNP和甲状腺激素的水平.结果 CHF组与对照组比较三碘甲状腺原氨酸（T3）、游离三碘甲状腺原氨酸（FT3）水平降低,差异有统计学意义,且随心功能不全程度加重,T3、F-T3、甲状腺素（T4）、游离甲状腺素（FT4）水平依次降低,NT-proBNP水平依次升高,LVEF水平依次下降,差异有统计学意义（P＜0.01）.结论 监测血清甲状腺激素水平,对判断心衰程度、治疗及预后有一定临床价值.     

老年慢性心力衰竭患者的正常甲状腺功能病态综合征

目的　探讨老年慢性心力衰竭患者中正常甲状腺功能病态综合征的情况及其与老年人病情和预后的关系。方法　运用化学发光免疫法测定老年慢性心力衰竭患者 (6 6例 )及对照组 (30例 )血浆三碘甲状腺原氨酸 (T3 )、甲状腺素 (T4)、游离三碘甲状腺原氨酸 (FT3 )、游离甲状腺素 (FT4)及促甲状腺素 (TSH)水平。结果　心力衰竭患者与对照组比较 ,T3 、FT3 明显降低 ,心力衰竭越重 ,降低越明显。心功能分级标准Ⅳ级患者T4、FT4及TSH较对照组降低明显 ,T4、FT4降低或合并TSH降低者 ,病死率高。结论　老年慢性心力衰竭患者常伴有正常甲状腺功能病态综合征 ,尤其是正常甲状腺功能病态综合征中低T3 低T4综合征为预后不良指标。甲状腺激素有望成为心力衰竭治疗中的一类新型药物。     

Immunosenescence and inflammation characterize chronic heart failure patients with more advanced disease

Background

Chronic heart failure (CHF) is characterized by an inflammatory status with high levels of cytokines such as IL-6. We hypothesized that patients with CHF may develop immunosenescence due to inflammation and that this may be associated with a worse stage of the disease.

Methods and results

We compared the immunological features of 58 elderly CHF patients (ECHF), 40 young CHF patients (YCHF), 60 healthy elderly controls (HEC) and 40 healthy young controls (HYC). We characterized leukocyte and lymphocyte subpopulations by flow cytometry, and IL-6 concentration by ELISA. The extent of CHF was classified according to functional and/or morphological criteria: New York Heart Association functional class, AHA/ACC heart failure stages, left ventricular ejection fraction, and left ventricular hypertrophy. CHF patients showed an increased number of leukocytes, neutrophils and monocytes, but a decreased number of lymphocytes. CHF patients had significantly lower levels of B-cells and CD4 + T-cells, increased NK-cells in YCHF, and increased CD8 + T-cells only in ECHF. CHF was associated with high differentiation in CD4 + and CD8 + T-lymphocyte subsets. Aging of T-lymphocyte subpopulations and high IL-6 levels were associated with a worse clinical status. IL-6 also correlated positively with the number of highly differentiated T-lymphocytes and with their accelerated aging.

Conclusions

We conclude that CHF patients show a higher degree of immunosenescence than age-matched healthy controls. T-lymphocyte differentiation and IL-6 levels are increased in patients with an advanced clinical status and may contribute to disease impairment through a compromised adaptive immune response due to accelerated aging of their immune system.     

慢性心力衰竭患者血浆B型利钠肽的测定及治疗的影响

目的：探讨血浆B型利钠肽（BNP）与慢性心力衰竭（CHF）的关系。方法：对48例CHF患者和10名正常人，以固相免疫分析法（IRMA）测定血浆BNP，其中33例心功能稳定于NYHAⅡ～Ⅲ级的CHF患者分为2组．随访3个月。A组（n=12）：应用地高辛、利尿剂和ACEI治疗；B组（n=21）：在上述治疗的基础上．加用卡维地洛。比较两组血浆BNP水平．及心脏彩超检查的心脏结构和功能变化。结果：（1）CHF患者血浆BNP水平显著升高，严重心衰患者更明显（P均〈0．05）；（2）两组治疗后血浆BNP水平均较治疗前显著降低（P〈0．05）；（3）治疗后心功能改善者血浆BNP水平下降较未改善者更明显（P〈0．05）；（4）B组心功能改善较A组更明显（P〈0．05）。结论：CHF患者血浆BNP水平升高．其水平随心衰加重而升高．提示BNP可作为评价心衰有价值的指标     

血浆白细胞介素18对老年慢性心力衰竭诊断及预后判断的作用

目的探讨血浆白细胞介素18(IL-18)对老年慢性心力衰竭(心衰)诊断及预后判断的作用。方法选择老年慢性心衰患者69例(心衰组)和同期健康体检老年人20例(对照组),采用ELISA法测定血浆IL-18、脑钠素(BNP)水平;用心功能分级(NYHA)标准对69例老年心衰患者的心功能进行分级,其中NYHAⅡ级22例,Ⅲ级27例,Ⅳ级20例。超声心动图测定LVEF。结果与对照组比较,心衰组患者血浆IL-18、BNP水平明显升高,LVEF明显降低,差异有统计学意义(P<0.01);与NYHAⅡ级比较,NYHAⅢ级和NYHAⅣ级患者血浆IL-18、BNP水平明显升高(P<0.01),LVEF明显降低(P<0.01);与NYHAⅢ级比较,NYHAⅣ级患者血浆IL-18、BNP水平明显升高(P<0.05,P<0.01)。心衰组患者血浆IL-18与BNP水平和NYHA分级呈正相关(r=0.689,P<0.01;r=0.730,P<0.01),与LVEF呈负相关(r=-0.598,P<0.01)。结论老年慢性心衰患者血浆IL-18水平明显升高,且与BNP、NYHA分级和LVEF具有较好的相关性。联合检测老年慢性心衰患者血浆IL-18、BNP水平有助于心衰诊断及判断预后。     

血清甲状腺激素水平对肺心病合并右心衰竭患者的临床意义

目的：研究分析肺心病合并右心衰患者的血清三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)等甲状腺激素检测的临床意义。方法选取本院收治的96例肺心病合并右心衰患者作为观察组,另选50例健康体检对象作为健康组,检测并比较两组人群的甲状腺激素水平并进行比较分析,并依据观察组患者的心功能分级进行分层分析。结果观察组患者的 T3、T4、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平显著的低于健康组患者且差异均具有统计学意义(P <0.05),观察组和健康组的促甲状腺激素(TSH)、甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)水平与健康组差异无统计学意义(P >0.05)。心功能Ⅱ级、Ⅲ级患者的 T3、T4、FT3、FT4显著的低于Ⅳ级心功能患者(P <0.05);观察组心功能Ⅱ级、Ⅲ级、Ⅳ级心功能患者的TSH、TGAb、TPOAb 水平差异无统计学意义(P >0.05)。结论肺心病合并右心衰患者的血清甲状腺激素水平较正常人群发生显著的改变,并且与患者的心功能具有一定的关系。     

免疫调节治疗对老年慢性心力衰竭患者细胞因子的影响

目的 研究免疫调节治疗对老年慢性充血性心力衰竭(CHF)患者心脏功能、细胞因子的影响.方法 入选96例年龄60～78岁CHF患者,美国纽约心功能分级(NYHA)Ⅱ～Ⅳ级,抽签随机分为治疗组(常规治疗的基础上加用胸腺五肽治疗,3个疗程,共75 d)和对照组(采用常规治疗),另以45例健康老年人为健康对照组,年龄60～80岁;分别在用药前、用药第1个疗程后(第15天)、第3个疗程后(第75天)测定各组患者的左心室射血分数(LVEF)、血清炎性细胞因子肿瘤坏死因子-α(TNF-α)及白细胞介素-1β(IL-1β),血清抗炎细胞因子白细胞介素-10(IL-10)、血浆高敏C反应蛋白(hsCRP)、血浆脑钠肽(BNP),并进行明尼苏达心力衰竭生活质量评分.结果 (1)治疗前,与健康对照组比较,治疗组和对照组患者血清TNF-α、IL-1β、TNF-α与IL-10比值、血浆BNP、hCRP、明尼苏达心力衰竭生活质量评分增高(P＜0.05或P＜0.01),LVEF、血清IL-10降低(P＜0.01),治疗组和对照组两组间比较各项指标差异无统计学意义;(2)第1个疗程后与对照组比较,治疗组的血清IL-10增高(P＜0.01);血清TNF-αIL-1β、血浆BNP、hsCRP降低(P＜0.05或P＜0.01);LVEF值有增高趋势,TNF-α与IL-10比值(治疗组与对照组分别为4.84±0.53与5.28±0.66)和生活质量评分有降低趋势,但差异无统计学意义.(3)第3个疗程后,与对照组比较,治疗组的血清IL-10、LVEF值显著增高(P＜0.05或P＜0.01);血清TNF-α、IL-1β、TNF-α与IL-10比值(治疗组与对照组分别为4.55±0.69与5.18±0.38)、血浆BNP、hsCRP和生活质量评分降低(P＜0.05或P＜0.01).结论 免疫调节剂胸腺肽能够改善细胞因子失衡,进而改善心功能;免疫调节治疗为老年CHF患者提供了新的治疗途径.

Abstract：

Objective To investigate the effect of immune modulation therapy on heart function and cytokines in elder patients with chronic heart failure (CHF). Methods The 96 patients aged 60-78 years with New York Heart Association(NYHA)functional. class Ⅱ-Ⅳ CHF were randomly divided into two groups: CHF treatment group received regular therapy and thymopetidum and CHF control group received regular therapy. Another 45 healthy individuals aged 60-80 years were involved as normal control. The ejection faction of left ventricle (LVEF), inflammatory cytokines including tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β), anti-inflammatory cytokine interleukin-10 (IL-10), plasma high sensitive C-reactive protein (hsCRP), plasma brain natrium peptide (BNP)and Minnesota Living with Heart Failure Questionnaire (LHFQ) assessment were tested before therapy, 15 days and 75 days after treatment. Results (1) Before therapy, compared with normal control group, the levels of TNF-α, IL-1β, TNF-α/IL-10 ratio, BNP, hsCRP and LHFQ were significantly increased (P ＜ 0. 05 or P ＜ 0. 01 ), and the levels of IL-10, LVEF were markedly decreased (P＜0.01) in the patients of CHF treatment group and CHF control group. While no difference between the two CHF groups was observed. (2) After the first course of treatment,compared with CHF control group, the levels of IL-10 were increased (P＜0. 01), while the levels of TNF-α, IL-1β, BNP and hsCRP were decreased (P＜0.05 or P＜0.01) in CHF treatment group. The level of LVEF was increased, TNF-α/IL-10 ratio (4.84 ±0. 53 vs. 5.28±0. 66) and LHFQ were decreased even though there was no significant difference between the two groups. (3) After the second course of treatment, compared with CHF control group, the levels of IL-10 and LVEF were increased (P＜0. 05 or P＜0.01), while the level of TNF-α, IL-1β, TNF-α/IL-10 ratio (4.55±0. 69 vs. 5.18±0.38), BNP, hsCRP and LHFQ were decreased (P＜0.05 or P＜0.01) in CHF treatment group. Conclusions Thymopetidum, as an immunemodulating agent, might regulate the equilibrium of cytokines and improve the heart function of patients with CHF, indicating that immune modulation therapy might improve the treatment strategy for CHF patients.     

Concentration of BNP, endothelin 1, pro-inflammatory cytokines (TNF-alpha, IL-6) and exercise capacity in patients with heart failure treated with carvedilol

BACKGROUND: Recent studies on the pathophysiology of heart failure indicate the role of neurohormones and immune and inflammatory processes as potential mechanisms involved in the pathogenesis and clinical course of chronic heart failure (CHF). AIM: To analyse the relationship between concentrations of brain natriuretic peptide (BNP), endothelin-1 (ET-1), inflammatory cytokines (TNF-alpha, IL-6) and cardiopulmonary stress test parameters, and to evaluate their changes during carvedilol treatment. METHODS: The study included 86 patients (81 men and 5 women) aged from 35 to 70 years (56.8+/-9.19) with symptomatic heart failure and left ventricular ejection fraction <40%, receiving an inhibitor of angiotensin II converting enzyme, diuretic and/or digoxin but not beta-blockers. All patients at baseline, and then at 3 and 12 months after treatment, underwent a panel of studies to assess functional capacity according to NYHA, echocardiographic and cardiopulmonary stress test (CPX) parameters, and serum concentrations of BNP, ET-1, TNF-alpha and IL-6. Before introducing carvedilol we found a weak relationship between concentrations of BNP, ET-1, IL-6 and decreased VO2 peak. RESULTS: At 12 months exercise tolerance was significantly improved (exercise stress testing prolonged by 143.9 s, p=0.001) and an increase in metabolic equivalent (MET) by 1.41 (p=0.001) was observed. The VO2 peak was nonsignificantly increased by a mean of 0.9 ml/kg/min. In patients with baseline VO2 peak <14 ml/kg/min the concentrations of ET-1 and TNF-alpha were significantly higher than in the remaining ones, and after treatment they were significantly reduced. In these patients VO2 peak%N was also significantly increased (39.5+/-7.5 vs. 50.1+/-15,0; p=0.013). The number of patients with VO2 peak <14 ml/kg/min also significantly decreased from 39 to 21 (p=0.013). CONCLUSIONS: In patients with HF decreased value of VO2 peak is associated with LV systolic function disorders and increased levels of BNP, ET-1, TNF-alpha and IL-6. Chronic treatment with carvedilol improves LV systolic function, exercise tolerance and peak oxygen consumption and is associated with significant decrease of BNP, ET-1, TNF-alpha and IL-6 concentrations.     

免疫调节治疗对老年心力衰竭患者心功能及淋巴细胞亚群的影响

目的 研究免疫调节治疗对老年慢性心力衰竭(心衰)患者心脏功能、淋巴细胞亚群的影响.方法 入选96例60岁以上、纽约心功能分级(NYHA分级)为Ⅱ～Ⅳ级的老年慢性心衰患者,随机分为心衰试验组和心衰对照组各48例.心衰对照组采用常规治疗,心衰试验组在常规治疗的基础上加用胸腺五肽治疗3个疗程(共75 d).另以45例60岁以上健康老年人作为正常组.分别在用药前、用药第一个疗程后(第15天)、第三个疗程后(第75天)测定各组患者的左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、淋巴细胞亚群、血浆高敏C反应蛋白(hsCRP)、血浆B型利钠肽(BNP)和6 min步行距离(6MWT).结果 (1)治疗前,与正常组相比,心衰试验组和心衰对照组患者的血浆BNP、血浆hsCRP、抑制性T淋巴细胞(CD8)、LVEDD和LVESD增高,成熟T淋巴细胞(CD3)、辅助性T淋巴细胞(CD4)、B淋巴细胞(CD19)、自然杀伤细胞(NK细胞)、CD4/CD8、LVEF、6MWT降低(P＜0.05或P＜0.01),心衰试验组和心衰对照组两组间比较各项指标差异无统计学意义.(2)第一疗程后,与心衰对照组相比,心衰试验组的血浆CD3、CD4、CD19和NK数量显著增高(P＜0.05或P＜0.01);血浆BNP、hsCRP和CD8数量显著降低(P＜0.05或P＜0.01);CD4/CD8、LVEF值及6MWT有增高趋势,LVEDD、LVESD和生活质量评分有降低趋势,但差异无统计学意义.(3)第三疗程后,与心衰对照组相比,心衰试验组的血浆CD3、CD4、CD19数量、NK数量、CD4/CD8、LVEF值和6MWT显著增高(P＜0.05或P＜0.01);血浆BNP、hsCRP和CD8数量和生活质量评分显著降低(P＜0.05或P＜0.01).结论 免疫调节剂胸腺肽能够改善心衰患者淋巴细胞亚群比例失衡,进而改善心功能;免疫调节治疗为老年心衰患者提供了新的治疗途径.     

Prognostic value of thyroid hormone levels in acute myocardial infarction: just an epiphenomenon?

The purpose of this study was to investigate whether thyroid hormone levels have any predictive value for mortality in patients presenting to the emergency department with acute myocardial infarction (AMI). Three groups of patients admitted to the emergency department within the 11-month study period were considered eligible: 95 patients with chest pain and proven AMI, 26 patients with chest pain and no AMI, and 114 patients who served as controls with no evidence of any major disease. Cardiac enzymes and the following thyroid hormones were analyzed and compared between groups, regarding effects of historical and demographic factors: thyrotrophin, free triiodothyronine (FT3), total triiodothyronine (TT3), free thyroxine (FT4), and total thyroxine (TT4). Sixteen patients with AMI (16.8%) died within the study period. Troponin T and creatine kinase-B with an M-type subunit levels were significantly higher in the nonsurvivors when compared with survivors. Survivors in the AMI group had higher TT3, TT4, and lower FT4 levels, while the nonsurvivors in the AMI group had higher thyrotrophin and lower TT3, FT3 and FT4 levels than controls. In the AMI group, the nonsurvivors had lower TT3 and FT3 levels than the survivors. A history of diabetes mellitus and/or angina, TT3, or FT3 was an independent predictor of mortality. TT3 and FT3 appear to be independent prognostic factors in patients with AMI.     

Angiotensin II type 1 receptor antagonist decreases plasma levels of tumor necrosis factor alpha, interleukin-6 and soluble adhesion molecules in patients with chronic heart failure

OBJECTIVES: To evaluate the effects of an angiotensin (Ang II) type 1 receptor antagonist on immune markers in patients with congestive heart failure (CHF). BACKGROUND: Ang II stimulates production of immune factors via the Ang II type 1 receptor in vitro, and the long-term effects of Ang II type 1 receptor antagonists on plasma markers of immune activation are unknown in patients with CHF. METHODS: Twenty-three patients with mild to moderate CHF with left ventricular dysfunction were randomly divided into two groups: treatment with Ang II type 1 receptor (candesartan cilexetil) (n = 14) or placebo (n = 9). We measured plasma levels of immune factors such as tumor necrosis factor alpha (TNFalpha), interleukin-6 (IL-6), soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1). We also measured plasma levels of the neurohumoral factors such as atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) and cyclic guanosine monophosphate (cGMP), a biological marker of ANP and BNP. RESULTS: Plasma levels of TNFalpha, IL-6, sICAM-1 and sVCAM-1 were increased in the 23 CHF patients compared with normal subjects and significantly decreased after 14 weeks of candesartan cilexetil treatment, but did not change in the placebo group. Plasma levels of BNP, which is a marker of ventricular injury, significantly decreased, and the molar ratio of plasma cGMP to cardiac natriuretic peptides (ANP + BNP) was significantly increased after candesartan cilexetil treatment, but did not change in the placebo group. CONCLUSIONS: These findings suggest that 14 weeks of treatment with an Ang II type 1 receptor antagonist (candesartan cilexetil) decreased plasma levels of the immune markers such as TNFalpha, IL-6, sICAM-1 and sVCAM-1 and that it improved the biological compensatory action of endogenous cardiac natriuretic peptides in patients with mild to moderate CHF.     

心力衰竭患者甲状腺激素改变的临床意义

心力衰竭患者甲状腺激素水平可有明显改变,且心力衰竭越严重,其T3、FT3水平下降与rT3水平升高越明显,而TSH无明显变化.提示甲状腺激素变化或许可以作为判断心力衰竭严重程度的参考指标.     

The role of cytokines and cortisol in the non-thyroidal illness syndrome following acute myocardial infarction

OBJECTIVE: A number of different hormone changes have been described during the acute myocardial infarction (AMI), including those of the non-thyroidal illness syndrome (NTIS). DESIGN AND METHODS: We assessed the alterations of serum thyroid hormones, cytokines and cortisol levels in 30 patients with a first episode of AMI 4, 24, 48h and 10 days (240h) after the onset of the chest pain and we investigated the possible relationship of these alterations with the severity of AMI. RESULTS: Fifteen patients had left ventricular ejection fraction (LVEF) 50% (group II). A transient decrease of total tri-iodothyronine (T(3)), more prominent in group I (P<0.05, t-test) with a concomitant rise of reverse T(3 )(rT(3)) occurred at 24h. Total thyroxine (T(4)), free T(4) (FT(4)) and free T(4) index did not change significantly, but tended to be higher in group I patients, whereas TSH significantly increased in group II at 48h. Interleukin-6 (IL-6) increased significantly at 24h only in group I and declined thereafter (24 vs 240h, P<0.001) and this temporal change of IL-6 was associated with similar changes of creatine phosphokinase and creatine kinase isoenzyme MB (CK-MB). Tumor necrosis factor-alpha and IL-1beta remained low in both groups. Cortisol was higher at 4h and in 12 patients was above the normal values. Negative correlation was found between LVEF and IL-6 (P<0. 001), whereas T(3), T(4) or cortisol levels were not correlated with the LVEF. CONCLUSIONS: Our data indicate that NTIS, in association with increase of IL-6, occurs in the early post-infarction period. In the NTIS following AMI the high level of IL-6 is the best predictor, among several parameters, of the severity of AMI as assessed by the LVEF and the rise of CK-MB.     

心脏起搏对血浆脑利钠肽影响的临床研究

研究DDD与VVI起搏方式对血浆脑利钠肽 (BNP)水平的影响及其临床意义。 4 7例安装了起搏器心功能II级以上患者 ,分为DDD起搏组与VVI起搏组 ,术前测血浆BNP值及行心脏彩色多普勒超声检查 ,术后 4～ 6月内随访血浆BNP、心脏彩色多普勒超声检查。比较两组患者BNP差别、心脏射血分数 (EF)差异。结果 :DDD起搏组BNP水平较VVI组为低 (5 7.2 3± 19.19pg/mlvs 88.35± 2 3.11pg/ml,P <0 .0 5 ) ;EF值在DDD起搏组较VVI组为高 (0 .5 6± 0 .0 8vs 0 .4 5± 0 .16 ,P <0 .0 5 )。两组患者的BNP与LVEF均呈显著负性相关 (P <0 .0 5 )。结论 :DDD起搏与VVI起搏方式相比血浆BNP水平较低 ,对慢性心功能不全患者的心脏功能影响较小。