CAJ | 학술논문

背景:充血性心力衰竭血清中一些细胞因子如白细胞介素6和肿瘤坏死因子α以及神经激素如去甲肾上腺素对于心力衰竭发生发展过程中是否起到重要作用.目的:探讨心力衰竭患者血清肿瘤坏死因子α、白细胞介素6,去甲肾上腺素的变化及意义,为判定心力衰竭严重程度及预后提供依据.设计:病例对照研究.单位:上海市市东医院心内科.方法:选择2000-01/2001-10上海市市东医院心内科住院心力衰竭患者58例(患者组),男33例,女25例.按纽约心脏病学会心功能分级,其中Ⅱ级12例,Ⅲ级32例,Ⅳ级14例.选择同期本院自愿健康体检者30例为对照组,男18例,女12例.采用酶联免疫双抗体夹心法测定血清肿瘤坏死因子α,白细胞介素6,去甲肾上腺素水平,用二维心脏超声测定左室射血分数,以此来观察血清细胞因子与心功能之间的关系.结果:①心功能Ⅲ级,Ⅳ级患者血清白细胞介素6[(367.6±78.6),(569.7±117.3)ng/L],肿瘤坏死因子醄(395.3,(583.1±124.8)ng/L],NE[(396.5±85.3),(675.9±136.2)ng/L]水平明显高于心功能Ⅱ级和对照组[(221.5±58.4),(170.2±42.7)ng/L;(205.4±59.2),(180.3±43.8)ng/L;(227.4±65.6),(163.8±41.5)ng/L,P均＜0.05].心功能Ⅱ级患者与对照组比较,差异无显著性意义(P＞0.05).②白细胞介素6,肿瘤坏死因子?去甲肾上腺素与左室射血分数呈高度负相关(r=-0.63,P＜0.01;r=-0.54,P＜0.05;r=-0.58,P＜0.01).心力竭衰程度越重,血清肿瘤坏死因子?白细胞介素6和去甲肾上腺素水平越高.肿瘤坏死因子嵊肴ゼ咨錾舷偎?白细胞介素6与去甲肾上腺素呈明显正相关(r=0.57,P＜0.01;r=0.51,P＜0.05).心力衰竭患者心力衰竭越重,血清白细胞介素6与肿瘤坏死因子崴皆礁?且两者呈正相关(r=0.39,P＜0.05).结论:心力衰竭患者血清肿瘤坏死因子岷桶紫赴樗?水平均升高,尤其在中重度心力衰竭患者中更加明显,并与左室射血分数呈负相关,提示血清白细胞介素6、肿瘤坏死因子崴娇勺魑牧λソ哐现爻烫度判断与预后的指标,并为康复干预措施介入提供量化评估依据. 揹景:充血性心力衰竭血清中一些細胞因子如白細胞介素6和腫瘤壞死因子α以及神經激素如去甲腎上腺素對于心力衰竭髮生髮展過程中是否起到重要作用.目的:探討心力衰竭患者血清腫瘤壞死因子α、白細胞介素6,去甲腎上腺素的變化及意義,為判定心力衰竭嚴重程度及預後提供依據.設計:病例對照研究.單位:上海市市東醫院心內科.方法:選擇2000-01/2001-10上海市市東醫院心內科住院心力衰竭患者58例(患者組),男33例,女25例.按紐約心髒病學會心功能分級,其中Ⅱ級12例,Ⅲ級32例,Ⅳ級14例.選擇同期本院自願健康體檢者30例為對照組,男18例,女12例.採用酶聯免疫雙抗體夾心法測定血清腫瘤壞死因子α,白細胞介素6,去甲腎上腺素水平,用二維心髒超聲測定左室射血分數,以此來觀察血清細胞因子與心功能之間的關繫.結果:①心功能Ⅲ級,Ⅳ級患者血清白細胞介素6[(367.6±78.6),(569.7±117.3)ng/L],腫瘤壞死因子醄(395.3,(583.1±124.8)ng/L],NE[(396.5±85.3),(675.9±136.2)ng/L]水平明顯高于心功能Ⅱ級和對照組[(221.5±58.4),(170.2±42.7)ng/L;(205.4±59.2),(180.3±43.8)ng/L;(227.4±65.6),(163.8±41.5)ng/L,P均＜0.05].心功能Ⅱ級患者與對照組比較,差異無顯著性意義(P＞0.05).②白細胞介素6,腫瘤壞死因子?去甲腎上腺素與左室射血分數呈高度負相關(r=-0.63,P＜0.01;r=-0.54,P＜0.05;r=-0.58,P＜0.01).心力竭衰程度越重,血清腫瘤壞死因子?白細胞介素6和去甲腎上腺素水平越高.腫瘤壞死因子嵊餚ゼ咨鏨舷偎?白細胞介素6與去甲腎上腺素呈明顯正相關(r=0.57,P＜0.01;r=0.51,P＜0.05).心力衰竭患者心力衰竭越重,血清白細胞介素6與腫瘤壞死因子崴皆礁?且兩者呈正相關(r=0.39,P＜0.05).結論:心力衰竭患者血清腫瘤壞死因子岷桶紫赴樗?水平均升高,尤其在中重度心力衰竭患者中更加明顯,併與左室射血分數呈負相關,提示血清白細胞介素6、腫瘤壞死因子崴嬌勺魑牧λソ哐現爻燙度判斷與預後的指標,併為康複榦預措施介入提供量化評估依據.
배경:충혈성심력쇠갈혈청중일사세포인자여백세포개소6화종류배사인자α이급신경격소여거갑신상선소대우심력쇠갈발생발전과정중시부기도중요작용.목적:탐토심력쇠갈환자혈청종류배사인자α、백세포개소6,거갑신상선소적변화급의의,위판정심력쇠갈엄중정도급예후제공의거.설계:병례대조연구.단위:상해시시동의원심내과.방법:선택2000-01/2001-10상해시시동의원심내과주원심력쇠갈환자58례(환자조),남33례,녀25례.안뉴약심장병학회심공능분급,기중Ⅱ급12례,Ⅲ급32례,Ⅳ급14례.선택동기본원자원건강체검자30례위대조조,남18례,녀12례.채용매련면역쌍항체협심법측정혈청종류배사인자α,백세포개소6,거갑신상선소수평,용이유심장초성측정좌실사혈분수,이차래관찰혈청세포인자여심공능지간적관계.결과:①심공능Ⅲ급,Ⅳ급환자혈청백세포개소6[(367.6±78.6),(569.7±117.3)ng/L],종류배사인자도(395.3,(583.1±124.8)ng/L],NE[(396.5±85.3),(675.9±136.2)ng/L]수평명현고우심공능Ⅱ급화대조조[(221.5±58.4),(170.2±42.7)ng/L;(205.4±59.2),(180.3±43.8)ng/L;(227.4±65.6),(163.8±41.5)ng/L,P균＜0.05].심공능Ⅱ급환자여대조조비교,차이무현저성의의(P＞0.05).②백세포개소6,종류배사인자?거갑신상선소여좌실사혈분수정고도부상관(r=-0.63,P＜0.01;r=-0.54,P＜0.05;r=-0.58,P＜0.01).심력갈쇠정도월중,혈청종류배사인자?백세포개소6화거갑신상선소수평월고.종류배사인자승효ゼ자참현외?백세포개소6여거갑신상선소정명현정상관(r=0.57,P＜0.01;r=0.51,P＜0.05).심력쇠갈환자심력쇠갈월중,혈청백세포개소6여종류배사인자외개초?차량자정정상관(r=0.39,P＜0.05).결론:심력쇠갈환자혈청종류배사인자민통자부저?수평균승고,우기재중중도심력쇠갈환자중경가명현,병여좌실사혈분수정부상관,제시혈청백세포개소6、종류배사인자외교작리목λソ광현효탕도판단여예후적지표,병위강복간예조시개입제공양화평고의거.
BACKGROUND: There are some cytokines like interleukin-6, tumor necrosis factor-alpha as well as neurohormones such as norepinerphrine in serum of patients with congestive heart failure. However, whether they influence the occurrence and development of congestive heart failure is uncertain.OBJECTIVE: To explore the changes and significance of interleukin-6,tumor necrosis factor-alpha and norepinerphrine in order to provide basis for assessing the severity of heart failure and its prognosis.DESIGN: A case control study.SETTING: Department of Cardiology, Shidong Hospital of Shanghai City.INTERVENTIONS: A total of 58 patients with congestive heart failure admitted to Department of Cardiology, Shidong Hospital of Shanghai City from January 2000 to October 2001 were chosen as patient group with 33 males and 25 females. According to NYHA heart function classification,there were 12 cases of level Ⅱ, 32 cases with level Ⅲ and 14 cases of level Ⅳ. Thirty healthy volunteers who took physical examination during the same time were chosen as control group with 18 males and 12 females.ELISA was used to assay the levels of interleukin-6, tumor necrosis factoralpha and norepinerphrine in serum while two-dimension echocardiography was used to test the left ventricular ejection fraction in order to observe the relationship between cytokines and heart function.RESULTS: ① The levels of interleukin-6 [(367.6±78.6), (569.7±117.3)ng/L], tumor necrosis factor-alpha [(395.3±82.4), (583.1±124.8) ng/L] and norepinerphrine [(396.5±85.3),(675.9±136.2) ng/L] in patients with level Ⅰ-Ⅱ, Ⅳ heart function was remarkably higher than those of patients with level Ⅱ heart function and people in control group[(221.5±58.4), (170.2±42.7)ng/L; (205.4±59.2), (180.3±43.8) ng/L; (227.4±65.6),(163.8±41.5) ng/L] (P ＜ 0.05). Compared patients of level Ⅱ heart function with people in the control group, there was no difference on the above indicators (P ＞ 0.05).②There was highly negative correlation between interleukin-6, tumor necrosis factor-alpha, norepinerphrine and left ventricular ejection fraction (r=-0.63, P＜ 0.01; r=-0.54, P＜ 0.05;r=-0.58,P ＜ 0.01). The more severe the heart failure, the higher the levels of interleukin-6, tumor necrosis factor-alpha and norepinerphrine. There was obviously positive correlation between tumor necrosis factor-alpha and norepinerphrine as well as between interleukin-6 and norepinerphrine (r=0.57,P ＜ 0.01;r=0.51,P ＜ 0.05). The more severe the heart failure, the higher the level of interleukin-6 and tumor necrosis factor-alpha and that there was positive correlation between them (r=0.39, P ＜ 0.05).CONCLUSION: The tumor necrosis factor-alpha and interleukin-6 levels in patients with congestive heart failure all increased, especially in patients with moderate or severe congestive heart failure, and represented negative correlation with left ventricular ejection fraction. It suggests that the levels of interleukin-6, tumor necrosis factor-alpha in serum can be used as indicators to assess the severity and prognosis of congestive heart failure and provide assessment basis for quantitative evaluation of rehabilitation interventions.