慢性心力衰竭患者贫血与肾功能和神经内分泌细胞因子的关系

目的探讨慢性心力衰竭(CHF)患者贫血与肾功能和神经内分泌细胞因子之间的关系。方法对入选的121例CHF患者测定血红蛋白(Hb)、肾功能、TNF-α、可溶性细胞间黏附分子-1(sICAM-1)、白细胞介素-6(IL-6)、血管紧张素Ⅱ(AngⅡ)、NO、内皮素(ET)的变化;超声心动图测量LVEF,评价心功能;按Hb水平分为贫血组(47例)和非贫血组(74例)。结果随着心功能恶化,CHF患者LVEF和Hb水平逐渐降低,而尿素、肌酐(Cr)、血尿酸(BUA)水平明显增高(P<0.01);贫血发生率为38.8%,肾功能障碍发生率为24.0%,随着LVEF下降,贫血和肾功能障碍逐渐增加且程度加重(P<0.05)。贫血组患者血清TNF-α、sICAM-1、IL-6、AngⅡ、NO、ET水平明显高于非贫血组(P<0.01)。Hb和LVEF与尿素、Cr、BUA呈负相关;Hb与TNF-α、sICAM-1、IL-6、AngⅡ、NO、ET呈负相关,而与LVEF呈正相关(P<0.01)。结论CHF患者机体存在细胞因子的过度表达和肾素-血管紧张素系统的过度激活及伴随肾功能的降低,可能导致了CHF患者贫血的发生,且贫血也参与并加重了CHF发生发展的病理生理过程。

Relation between anemia and renal insufficiency, neurohormonal cytokines in patients with CHF

Objective To study association of anemia with renal insufficiency and neurohormonal cytokine activation in patients with congestive heart failure(CHF).Methods Hb concentration,renal function,serum tumor necrosis factor-α(TNF-α),soluble intercellular adhesion molecule-1(sICAM-1),interleukin-6(IL-6),angiotensinⅡ(AngⅡ),NO and endothelin(ET) in 121 CHF patients were measured.Left ventricular ejection fraction(LVEF) was measured by echocardiography.Results Hb concentration significantly decreased,and the levels of blood urea,Cr,BUA increased with deterioration of cardiac function in CHF patients.38.8% of the patients had anemia and 24.0% had renal insufficiency.The anemia and renal insnfficiency aggravated with decreasing LVEF.The levels of TNF-α,sICAM-1,IL-6,AngⅡ,NO and ET in the anemia group of CHF patients were higher than those in the non-anemia group.With the increase in anemia severity,the levels of TNF-α,sICAM-1,IL-6,AngⅡ,NO and ET significantly increased.There were negative correlations between the levels of TNF-α,sICAM-1,IL-6,AngⅡ and Hb concentration(P<0.01).Conclusion Increase in the levels of TNF-α,sICAM-1,IL-6 and AngⅡ plays roles in pathophysiological and pathogenetic mechanism of anemia in CHF,and correlates with the severity of anemia in CHF.