CAJ | 학술논문

目的研究免疫调节治疗对老年慢性充血性心力衰竭(CHF)患者心脏功能、细胞因子的影响.方法入选96例年龄60～78岁CHF患者,美国纽约心功能分级(NYHA)Ⅱ～Ⅳ级,抽签随机分为治疗组(常规治疗的基础上加用胸腺五肽治疗,3个疗程,共75 d)和对照组(采用常规治疗),另以45例健康老年人为健康对照组,年龄60～80岁;分别在用药前、用药第1个疗程后(第15天)、第3个疗程后(第75天)测定各组患者的左心室射血分数(LVEF)、血清炎性细胞因子肿瘤坏死因子-α(TNF-α)及白细胞介素-1β(IL-1β),血清抗炎细胞因子白细胞介素-10(IL-10)、血浆高敏C反应蛋白(hsCRP)、血浆脑钠肽(BNP),并进行明尼苏达心力衰竭生活质量评分.结果 (1)治疗前,与健康对照组比较,治疗组和对照组患者血清TNF-α、IL-1β、TNF-α与IL-10比值、血浆BNP、hCRP、明尼苏达心力衰竭生活质量评分增高(P＜0.05或P＜0.01),LVEF、血清IL-10降低(P＜0.01),治疗组和对照组两组间比较各项指标差异无统计学意义;(2)第1个疗程后与对照组比较,治疗组的血清IL-10增高(P＜0.01);血清TNF-αIL-1β、血浆BNP、hsCRP降低(P＜0.05或P＜0.01);LVEF值有增高趋势,TNF-α与IL-10比值(治疗组与对照组分别为4.84±0.53与5.28±0.66)和生活质量评分有降低趋势,但差异无统计学意义.(3)第3个疗程后,与对照组比较,治疗组的血清IL-10、LVEF值显著增高(P＜0.05或P＜0.01);血清TNF-α、IL-1β、TNF-α与IL-10比值(治疗组与对照组分别为4.55±0.69与5.18±0.38)、血浆BNP、hsCRP和生活质量评分降低(P＜0.05或P＜0.01).结论免疫调节剂胸腺肽能够改善细胞因子失衡,进而改善心功能;免疫调节治疗为老年CHF患者提供了新的治疗途径.
목적 연구면역조절치료대노년만성충혈성심력쇠갈(CHF)환자심장공능、세포인자적영향.방법 입선96례년령60～78세CHF환자,미국뉴약심공능분급(NYHA)Ⅱ～Ⅳ급,추첨수궤분위치료조(상규치료적기출상가용흉선오태치료,3개료정,공75 d)화대조조(채용상규치료),령이45례건강노년인위건강대조조,년령60～80세;분별재용약전、용약제1개료정후(제15천)、제3개료정후(제75천)측정각조환자적좌심실사혈분수(LVEF)、혈청염성세포인자종류배사인자-α(TNF-α)급백세포개소-1β(IL-1β),혈청항염세포인자백세포개소-10(IL-10)、혈장고민C반응단백(hsCRP)、혈장뇌납태(BNP),병진행명니소체심력쇠갈생활질량평분.결과 (1)치료전,여건강대조조비교,치료조화대조조환자혈청TNF-α、IL-1β、TNF-α여IL-10비치、혈장BNP、hCRP、명니소체심력쇠갈생활질량평분증고(P＜0.05혹P＜0.01),LVEF、혈청IL-10강저(P＜0.01),치료조화대조조량조간비교각항지표차이무통계학의의;(2)제1개료정후여대조조비교,치료조적혈청IL-10증고(P＜0.01);혈청TNF-αIL-1β、혈장BNP、hsCRP강저(P＜0.05혹P＜0.01);LVEF치유증고추세,TNF-α여IL-10비치(치료조여대조조분별위4.84±0.53여5.28±0.66)화생활질량평분유강저추세,단차이무통계학의의.(3)제3개료정후,여대조조비교,치료조적혈청IL-10、LVEF치현저증고(P＜0.05혹P＜0.01);혈청TNF-α、IL-1β、TNF-α여IL-10비치(치료조여대조조분별위4.55±0.69여5.18±0.38)、혈장BNP、hsCRP화생활질량평분강저(P＜0.05혹P＜0.01).결론 면역조절제흉선태능구개선세포인자실형,진이개선심공능;면역조절치료위노년CHF환자제공료신적치료도경.
Objective To investigate the effect of immune modulation therapy on heart function and cytokines in elder patients with chronic heart failure (CHF). Methods The 96 patients aged 60-78 years with New York Heart Association(NYHA)functional. class Ⅱ-Ⅳ CHF were randomly divided into two groups: CHF treatment group received regular therapy and thymopetidum and CHF control group received regular therapy. Another 45 healthy individuals aged 60-80 years were involved as normal control. The ejection faction of left ventricle (LVEF), inflammatory cytokines including tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β), anti-inflammatory cytokine interleukin-10 (IL-10), plasma high sensitive C-reactive protein (hsCRP), plasma brain natrium peptide (BNP)and Minnesota Living with Heart Failure Questionnaire (LHFQ) assessment were tested before therapy, 15 days and 75 days after treatment. Results (1) Before therapy, compared with normal control group, the levels of TNF-α, IL-1β, TNF-α/IL-10 ratio, BNP, hsCRP and LHFQ were significantly increased (P ＜ 0. 05 or P ＜ 0. 01 ), and the levels of IL-10, LVEF were markedly decreased (P＜0.01) in the patients of CHF treatment group and CHF control group. While no difference between the two CHF groups was observed. (2) After the first course of treatment,compared with CHF control group, the levels of IL-10 were increased (P＜0. 01), while the levels of TNF-α, IL-1β, BNP and hsCRP were decreased (P＜0.05 or P＜0.01) in CHF treatment group. The level of LVEF was increased, TNF-α/IL-10 ratio (4.84 ±0. 53 vs. 5.28±0. 66) and LHFQ were decreased even though there was no significant difference between the two groups. (3) After the second course of treatment, compared with CHF control group, the levels of IL-10 and LVEF were increased (P＜0. 05 or P＜0.01), while the level of TNF-α, IL-1β, TNF-α/IL-10 ratio (4.55±0. 69 vs. 5.18±0.38), BNP, hsCRP and LHFQ were decreased (P＜0.05 or P＜0.01) in CHF treatment group. Conclusions Thymopetidum, as an immunemodulating agent, might regulate the equilibrium of cytokines and improve the heart function of patients with CHF, indicating that immune modulation therapy might improve the treatment strategy for CHF patients.