CAJ | 학술논문

目的探讨慢性心力衰竭(CHF)患者血红蛋白(Hb)水平变化与神经内分泌激素、细胞因子和B型钠尿肽(BNP)的关系及对心室重构的影响.方法对入选的121例CHF患者测定Hb、血管紧张素Ⅱ(Ang Ⅱ)、肿瘤坏死因子(TNF)-α、一氧化氮(NO)、细胞间黏附分子(ICAM)-1、BNP水平,超声心动图测量左室射血分数(LVEF),评价心功能,计算左心室质量指数(LVMI)和平均室壁应力(MWS);CHF患者按Hb水平分为贫血组和非贫血组.同时选择27例健康人为对照组.结果 CHF组患者AngⅡ、TNF-α、NO和ICAM-1、BNP水平以及LVMI和MWS高于对照组(均为P＜0.01),而Hb水平和LVEF低于对照组;随着Ang Ⅱ、TNF-α、NO、ICAM-1、BNP水平以及MWS和LVMI升高,Hb水平逐渐降低,心功能指标下降;CHF贫血组Ang Ⅱ、TNF-α、NO、ICAM-1、BNP水平及MWS和LVMI高于非贫血组,分别[为(144.5±64.1)ng/L与(76.7±48.5)ng/L、(92.3±6.4)ng/L与(55.6±10.2)ng/L、(65.2±4.2)μmol/L与(42.1±11.9)μmol/L、(253.6±26.0)μg/L和(237.2±33.3)μg/L、(1294.0±223.0)ng/L与(437.0±115.0)ng/L、P＜0.01];随着AngⅡ、TNF-α、NO、ICAM-1、BNP水平以及MWS和LVMI进一步升高,CHF患者贫血程度加重;CHF患者Hb与AngⅡ、TNF-α、NO、ICAM-1、BNP水平及LVMI和MwS均呈负相关(r分别为-0.8173、-0.8509、-0.6001、-0.6692、-0.6283、-0.8604、-0.8733,P＜0.01).结论 CHF患者神经内分泌激素激活、细胞因子过度表达参与了心室重构和贫血发生发展的病理过程,而贫血使心室重构程度加重.
목적 탐토만성심력쇠갈(CHF)환자혈홍단백(Hb)수평변화여신경내분비격소、세포인자화B형납뇨태(BNP)적관계급대심실중구적영향.방법 대입선적121례CHF환자측정Hb、혈관긴장소Ⅱ(Ang Ⅱ)、종류배사인자(TNF)-α、일양화담(NO)、세포간점부분자(ICAM)-1、BNP수평,초성심동도측량좌실사혈분수(LVEF),평개심공능,계산좌심실질량지수(LVMI)화평균실벽응력(MWS);CHF환자안Hb수평분위빈혈조화비빈혈조.동시선택27례건강인위대조조.결과 CHF조환자AngⅡ、TNF-α、NO화ICAM-1、BNP수평이급LVMI화MWS고우대조조(균위P＜0.01),이Hb수평화LVEF저우대조조;수착Ang Ⅱ、TNF-α、NO、ICAM-1、BNP수평이급MWS화LVMI승고,Hb수평축점강저,심공능지표하강;CHF빈혈조Ang Ⅱ、TNF-α、NO、ICAM-1、BNP수평급MWS화LVMI고우비빈혈조,분별[위(144.5±64.1)ng/L여(76.7±48.5)ng/L、(92.3±6.4)ng/L여(55.6±10.2)ng/L、(65.2±4.2)μmol/L여(42.1±11.9)μmol/L、(253.6±26.0)μg/L화(237.2±33.3)μg/L、(1294.0±223.0)ng/L여(437.0±115.0)ng/L、P＜0.01];수착AngⅡ、TNF-α、NO、ICAM-1、BNP수평이급MWS화LVMI진일보승고,CHF환자빈혈정도가중;CHF환자Hb여AngⅡ、TNF-α、NO、ICAM-1、BNP수평급LVMI화MwS균정부상관(r분별위-0.8173、-0.8509、-0.6001、-0.6692、-0.6283、-0.8604、-0.8733,P＜0.01).결론 CHF환자신경내분비격소격활、세포인자과도표체삼여료심실중구화빈혈발생발전적병리과정,이빈혈사심실중구정도가중.
Objective To study the relationships of hemoglobin(Hb)level with the levels of neurohormones,and cytokines,and the effect of them on ventricular remodeling in patients with congestive heart failure(CHF). Methods Hb level,serum angiotensinⅡ(Ang Ⅱ ),tumor necrosis factor-α(TNF-α),nitric oxide(NO),soluble intereellular adhesion molecule-1(sICAM-1)and B-type natriuretic peptide(BNP)were measured in 121 CHF patients.The left ventrieular ejection fraction (LVEF)from echocardiography,left ventricular mass index(LVMI),and mean wall stress(MWS)were calculated. Results The levels of Ang Ⅱ,TNF-α,NO,siCAM-1,BNP[(144.5±64.1)ng/L,(92.3±6.4)ng/L,(65.2±4.2)μmol/L,(253.6±26.0)μg/L,(1294.0±223.0)ng/L]and LVMI,MWS in the anemia group of CHF patients were higher than those in the non-anemia group[(76.7±48.5)ng/L,(55.6±10.2)ng/L,(42.1±11.9)μmol/L,(237.18±33.26)μg/L,(437.0±115.0)ng/L,all P＜0.01].With the increase of anemia severity,the levels of AngⅡ,TNF-α,NO,siCAM-1,BNP and LVMI,MWS were significantly increased.There were negative correlations between Hb level and the 1evels of AngⅡ,TNF-α,NO,siCAM-1,BNP,LVMI,MWS(r=-0.8173,-0.8509,-0.6001,-0.6692,-0.6283,-0.8604,-0.8733,all P＜0.01),and negative correlations between LVMI,MWS and Hb levels and LVEF(P＜0.01). Conclusions Neurohormones and cytokines play roles in ventrieular remodeling and anemia in CHF aggravates the severity of ventricular remodeling.