己酮可可碱对慢性心力衰竭患者细胞因子的免疫调节及细胞凋亡抑制因子的影响

目的:探讨己酮可可碱(Pentoxifylline,PTX)对慢性心力衰竭(CHF)患者外周血辅助性T淋巴细胞(Th)免疫调节及血浆细胞凋亡抑制因子（Fas/Apo-1）水平的影响。方法: 采用流式细胞术，检测40例心力衰竭(HF)患者和10例正常对照者外周血CD4+Th1和Th2细胞及其分泌的细胞因子干扰素-γ( IFN-γ)和白介素-10(IL-10)的变化。采用ELISA法测定HF患者治疗前后外周血肿瘤坏死因子-α（TNF-α）、IL-10及Fas/Apo-1水平的变化。采用超声心动图检测HF患者射血分数(EF)的变化。结果: HF患者治疗1个月后，PTX治疗组与常规治疗组相比较，分泌IFN-γ的Th1型细胞所占百分比显著降低(P<0.01)；而分泌IL-10的Th2型细胞所占百分比明显升高(P<0.01)；外周血TNF-α及Fas/Apo-1的水平显著降低(分别为P<0.05和P<0.01)；EF显著提高(P<0.01)。结论: HF患者在常规治疗的基础上应用PTX治疗后，EF得到改善，可能与其对HF患者Th1/Th2细胞比例失衡产生的免疫调节作用，以及通过免疫调节影响炎性细胞因子和凋亡抑制因子的激活与分泌有关。

Effects of pentoxifylline on immune modulatory mechanism of CD~+4Th cells and soluble Fas in patients with congestive heart failure

AIM:To investigate the effects of pentoxifylline (PTX) on the immune modulatory mechanism of CD4+Th and soluble Fas in patients with chronic heart failure (CHF). METHODS: Cytokine-producing Th lymphocytes were quantified by 3-color flow cytometry in 40 CHF patients. Concentrations of TNF-α, IL-10 and Fas/Apo-1 were examined by ELISA, and the ejection fraction was measured by ultrasound echocardiography. RESULTS: The frequencies of IFN-γ-producing Th1 cells were significantly lower and the frequency of IL-10-producing Th2 cells was higher (P<0.01). Levels of TNF-α and Fas/Apo-1 were lower (P<0.05, P<0.01) and the ejection fraction was higher in PTX group than those in routine group after 1-month therapy. CONCLUSION: The improvement of ejection fraction resulting from conventional treatment plus pentoxifylline may be related with the effects of pentoxifylline on the immune modulation on Th1/Th2 functional imbalance in CHF patients and on the activation and secretion of inflammatory cytokines and Fas/Apo-1 through immune modulatory mechanisms.