慢性心力衰竭患者炎性细胞因子的变化及作用

目的探讨致炎细胞因子白细胞介素1(IL-1)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、γ干扰素(IFN-γ)和抗炎细胞因子白细胞介素10(IL-10)在慢性心力衰竭发生发展中的变化及作用。方法入选心力衰竭患者150例和健康对照50名,采用酶联免疫吸附法检测血清IL-1、IL-6、IL-10、TNF-α和IFN-γ的水平。结果心力衰竭组患者血清IL-1、IL-6、IL-10、TNF-α和IFN-γ的水平显著高于对照组(P<0.05或P<0.01),且随着纽约心功能分级(NYHA)的增加而升高,并与左心室射血分数(LVEF)呈负相关(r=-0.586、-0.454、-0.521、-0.514、-0.502,均为P<0.01),与左心室舒张末容积(LVEDV)呈正相关(r=0.603、0.45、0.542、0.519、0.438,均为P<0.01);IL-1、IL-6、TNF-α、IFN-γ总和与IL-10的比值:NYHAⅢ级和Ⅳ级患者高于对照组(P<0.05或P<0.01),NYHAⅣ级患者高于Ⅲ级和Ⅱ级患者(P<0.05),NYHAⅢ级患者高于Ⅱ级患者(P<0.05),但NYHAⅡ级患者与对照组间差异无统计学意义(P>0.05);冠心病心力衰竭和扩张型心肌病心力衰竭患者的IL-1、IL-6、IL-10、TNF-α和IFN-γ水平比较,差异无统计学意义(P>0.05)。结论心力衰竭患者致炎细胞因子和抗炎细胞因子均增高,但抗炎因子增加相对不足,炎症反应随着心力衰竭程度加重而加重,与心功能状态有相关性,与病因无显著相关性,细胞因子在心力衰竭的发生发展中起着重要的作用。

Changes and roles of serum cytokines in patients with chronic heart failure

Objective To study the changes and roles of serum cytokines interleukin-1(IL-1),interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α) and interferon(IFN-γ) in patients with chronic heart failure(CHF). Methods One hundred and fifty patients with CHF(CHF group) and 50 controls(control group) were enrolled in this study.Serum IL-1,IL-6,IL-10,TNF-α and IFN-γ were detected by enzyme linked immune absorption assay. Results Serum levels of IL-1,IL-6,IL-10,TNF-α,IFN-γ and the ratio of pro-inflammatory cytokine(the sum of IL-1,IL-6,IL-10,TNF-α,IFN-γ)/IL-10 in CHF group were significantly higher than in control group,and were positively correlated with left ventricular end diastolic volume(LVEDV)(r=0.603,0.45,0.542,0.519 and 0.438,respectively,all P<0.01) and negatively correlated with LVEF(r=-0.586,-0.454,-0.521,-0.514 and-0.502,respectively,all P<0.01),irrespective of the etiology of heart failure.Pro-inflammatory cytokine/IL-10 ratio was similar in CHF patients with NHHA class Ⅱ and controls(P>0.05). Conclusions The pro-inflammatory cytokines are increased and anti-inflammatory cytokine decreased in CHF patients.These changes are involved in development and progression of CHF.