慢性心力衰竭患者下丘脑-垂体-肾上腺轴节律变化与心功能的相关性分析

目的:探讨慢性心力衰竭(CHF)患者下丘脑-垂体-肾上腺轴(hypothalamic-pituitary-adrenal axis,HPA)水平及变化与心功能的关系。方法:连续入选108例CHF患者(非重症CHF组49例,重症CHF组59例),以及同期住院的非CHF患者43例。测定患者血浆总胆红素、白蛋白、肌酐、氨基末端利钠肽前体(N-terminal pro brain natriuretic peptide,NT-proBNP)、C反应蛋白(C-reactive protein,CRP)、游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、促甲状腺激素(thyroid-stimulating hormone,TSH)水平,计算肾小球滤过率(glomerular filtration rate,GFR)。测定同1天0:00、8:00及16:00的血浆促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)和皮质醇(cortisol,COR)水平,计算患者昼夜COR比值(RCOR8:00/COR0:00)及日间COR比值(RCOR8:00/COR16:00)。比较3组间上述指标的差异。结果:与较非CHF组相比,CHF组0:00血浆ACTH及0:00、16:00血浆COR水平显著升高,RCOR8:00/COR0:00及RCOR8:00/COR16:00均下降(P<0.05)。重症CHF组0:00、8:00血浆ACTH以及0:00、8:00、16:00血浆COR水平均高于非重症CHF组及非CHF组(P<0.05)。重症CHF组RCOR8:00/COR0:00低于非重症CHF组,非重症CHF组低于非CHF组(P<0.05)。结论:CHF患者HPA慢性持续性激活;COR随心功能状态动态变化,可作为反映CHF病情的指标,并对病情评估及预后判断具有较高价值。

Correlation between hypothalamic-pituitary-adrenal axis rhythm changes and cardiac function in patients with chronic heart failure

Objective: To investigate the relationship between hypothalamic-pituitary-adrenal axis (HPA) rhythm changes and cardiac function in patients with chronic heart failure (CHF). Methods: Consecutive 108 CHF patients (49 in the non-severe CHF group, 59 in the severe CHF group) and 43 non-CHF patients hospitalized in the same period were selected. The plasma levels of total bilirubin, albumin, creatinine, and N-terminal pro brain natriuretic peptide (NT-proBNP), C-reactive protein (CRP), free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH) were measured, and the glomerular filtration rate (GFR) was calculated. Plasma levels of adrenocorticotropic hormone (ACTH) and cortisol (COR) were measured at three time points of 0:00, 8:00, and 16:00 on the same day. Then the day and night COR ratio (R_{COR8:00/COR0:00}) and daytime COR ratio (R_{COR8:00/COR16:00}) were calculated. The differences of above indices among the three groups were compared. Results: Compared with non-CHF group, the plasma levels of ACTH at 0:00 and COR at 0:00 and 16:00 were significantly increased in CHF group, while R_{COR8:00/COR0:00} and R_{COR8:00/COR16:00} were significantly lower (P<0.05). The COR level at 0:00, 8:00 and ACTH level at 0:00, 8:00, 16:00 in severe CHF group were all higher than those in non-severe CHF group and non-CHF group (P<0.05). R_{COR8:00/COR0:00} decreased in turn in the non-CHF group, non-severe CHF group, and severe CHF group (P<0.05). Conclusions: HPA axis is chronically and persistently activated in CHF patients, and COR can be used as an indicator to reflect the severity of CHF, and plasma COR level may be of high value for disease assessment and prognosis judgment.