胺碘酮抑制肿瘤坏死因子-α生成对心力衰竭患者猝死的预防价值

目的观察胺碘酮抑制心力衰竭患者外周血单核细胞（PBMC）分泌的肿瘤坏死因子-α（（TNF-α）的生成对心力衰竭患者猝死的预防价值。方法160例慢性心力衰竭患者被随机分成胺碘酮组（80例，常规治疗＋胺碘酮，200mg，每日1次）和对照组（80例，常规治疗＋安慰剂）。在完成基线评估后，胺碘酮组服用胺碘酮片2年，对照组维持常规治疗。首要终点为全死因死亡，次级终点为猝死和心力衰竭患者心衰加重再入院率。随访期间观察心力衰竭患者左心室射血分数（LVEF）和TNF-α浓度变化。结果与对照组相比，胺碘酮组死亡率风险比下降29％（95％ CI 5％-45％，P=0．025），猝死率风险比下降32％（95％ CI 11％～48％，P=0．016），再入院风险比下降39％（95％ CI 14％-49％，P=0．0027）。胺碘酮显著提高了心力衰竭患者LVEF，抑制了TNF—α浓度（P均〈0．01），LVEF与TNF-α浓度呈显著负相关（r=0．31，P〈0．01）。结论胺碘酮通过抑制心力衰竭患者PBMC分泌的TNF—α的生成，能改善心力衰竭患者心功能，降低心力衰竭患者的死亡率和猝死率。

Amiodarone Inhibits the production of tumor necrosis factor-α:a study of the prevention value on sundden death in heart failure patients

Objective To observe the inhibition effect of amiodarone on the production of tumore necrosis factor-α（TNF-α） secreted by peripheral blood monouclear cells（PBMC） in heart failure patients. Methods 160 patients with chronic heart falure were enrolled and randomly assigned to amoidarone group （conventional therapy ＋ amoidarone,200 mg daily,n=80） and control group （conventional therapy＋placebo,n=80）. After evaluation of baseline characteristics, patients in amoidarone group received amiodarone tablets for 2 years, while control group maintained conventional therapy. Primary endpoint was all-canse mortality. Secondary endpoint consists of （a） sudden death., （b） the change of left ventricular ejection fraction （LVEF） and TNF-α concentration. Results Compared with control group, the mortality risk was 29% lower in amiodarone group （95% CI 5%-45% ,P=0.025）, the risk ratio of sudden death was 32% lower （95% CI, 11%-48%,P=0.016）, and the rehospitalization risk ratio was 39% lower （95% CI 14%-49%,P=0.0027）. Amiodarone significantly increased the LVEF level of heart failure patients （P〈0.01） and inhibited the TNF-α concentration （P〈0.01）, wherein LVEF is negatively correlated with the TNF-α concentration（r=0.31, P〈0.01 ）. Conclusion By inhibiting the production of TNF-α secreted by PBMC, amoidarone improves the heart function and decreases mortality and morbidity in heart failure patients.