血浆B型脑钠肽和肿瘤坏死因子水平变化与老年慢性心力衰竭患者心室重构的关系

目的观察老年慢性心力衰竭(CHF)患者不同心功能分级(NYHA)血浆B型脑钠肽(B-type natriuretic pep-tide,BNP)和TNF-α水平的变化,探讨其与左心室质量指数(LVMI)和平均室壁应力(MWS)及心功能变化之间的关系和临床意义。方法将81例CHF患者作为心衰组,同期选择27例健康体检者作为对照组。检测血浆BNP和TNF-α水平,评价心功能,超声心动图测量左心室射血分数(LVEF)、计算LVMI和MWS。结果与对照组比较,心衰组患者血浆BNP和TNF-α水平升高;随着心功能分级程度的加重和疾病的进展,血浆BNP和TNF-α水平逐渐升高,BNP与TNF-α呈正相关;与LVEF呈负相关(P<0.01);MWS和LVMI随心力衰竭程度的加重而增高,并与LVEF呈负相关(P<0.01),与BNP和TNF-α水平呈正相关(P<0.01);结论血浆BNP水平的增加与LVMI和MWS增加有关;TNF-α、LVMI和MWS协同参与心力衰竭发生发展的病理生理过程。

Relationships between plasma B-type natriuretic peptide, tumor necrosis factor-α and ventricular remodeling in patients with chronic heart failure

Objective To explore relationships between B-type natriuretic peptide(BNP),tumor necrosis factor-α(TNF-α) and left ventricular mass index(LVMI),mean wall stress(MWS)in patients with chronic heart failure(CHF).Methods CHF group included 81 patients,healthy control group included 27 healthy volunteers.The levels of plasma BNP and TNF-α were measured.LVDd,LVDs,IVSs,LVPWd and LVPWs were determined by echocardiography and LVMI,MWS and left ventricular ejection fraction(LVEF) were calculated.Results The levels of BNP,TNF-α and LVMI,MWS in the patients with CHF were higher than those in healthy subjects.With the increase in NYHA and progress of disease,the levels of BNP and TNF-α significantly increased.The level of BNP was positively correlated with TNF-α,but negatively correlated with LVEF(P<0.01).MWS and LVMI increased with aggravation of heart failure,and were negatively correlated with LVEF(P<0.01) and positively correlated with levels of BNP and TNF-α.Conclusion Changes of the levels of plasma BNP,TNF-α,LVMI and MWS in the patients with CHF can reflect impairment of the cardiac function and the degree of ventricular remodeling.Changes of the levels of TNF-α,LVMI and MWS play a role in the pathophysiological course and pathogenesis of chronic heart failure.