慢性心力衰竭患者外周血中sCD14水平的变化

目的 分析慢性心力衰竭患者(CHF)外周血可溶性CD14(sCD14)、C-反应蛋白(CRP)水平变化特点,探讨sCD14水平与CHF患者病因、临床症状及单核细胞数量的关系.方法 选取入院CHF患者246例,按病因、临床症状进行分组,并以107例健康人作为对照.入院次日清晨抽取静脉血,用ELISA法测定血清中的sCD14含量,速率散射比浊法测CRP浓度.结果 CHF组外周血CRP、sCD14水平较同年龄健康对照组显著性升高(P<0.01),不同临床症状组间有显著性差异(F=3.787,P=0.024),中重度临床症状组较无临床症状组显著性升高(P<0.05).病因不同的CHF组间sCD14水平有显著性差异(P<0.05),其中冠心病病因组与风湿病病因组均较高血压病因组显著性增高(P=0.009,P=0.016).CHF组sCD14水平与CRP水平及临床症状成显著正相关(r=0.396,P=0.000;r=0.206,P=0.001),而与单核细胞的绝对数及相对数无关.结论 sCD14和CRP水平在CHF患者外周血中明显升高,受病因及临床症状的影响,但sCD14水平的增高并非由单核细胞数量增加引起.

Variation of serum soluble CD14 levels in patients with chronic heart failure

OBJECTIVE: To analyze the patterns of serum soluble CD14 (sCD14) and C-reactive protein (CRP) alterations in patients with chronic heart failure (CHF) and investigate the correlations of sCD14 variation to the etiology, clinical symptoms, and the number of mononuclear cells in these patients. METHODS: This study involved 246 CHF patients stratified according to their etiology and clinical symptoms, with 107 normal individuals serving as the control group. Blood samples were collected from these patients the next day after admission and also from the control subjects for measuring serum sCD14 and CPR levels using enzyme-linked immunosorbent assay (ELISA) and rate nephelometry, respectively. RESULTS: The CHF patients had significantly higher serum levels of sCD14 and CRP than the control subjects (P<0.01). In the CHF patients, serum sCD14 and CRP levels differed significantly in the patients with clinical symptoms of different severities (F=3.787, P=0.024), and those with moderate and severe symptoms had significantly higher levels than the asymptomatic patients (P<0.05). The difference in etiologies also resulted in significant difference in sCD14 levels (P<0.05), which were significantly lower in coronary artery disease group than in hypertension group (P<0.05). Significant positive correlations were found between sCD14 and the CRP levels in the CHF patients (r=0.227, P=0.018) and between sCD14 level and the clinical symptoms (r=0.206, P=0.001), but sCD14 level was not correlated to the absolute or relative number of mononuclear cells. CONCLUSIONS: Serum sCD14 and CRP levels are significantly elevated in CHF patients, but this condition may vary as the etiologies and clinical symptoms differ. Increased mononuclear cells do not contribute to the elevation of serum sCD14.