慢性心力衰竭患者血清TNF-α、BNP、Cys-C水平与心肾功能的关系
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摘要
目的探讨慢性心力衰竭(CHF)患者血清肿瘤坏死因子-α(TNF-α)、脑钠肽(BNP)、胱抑素C(Cys-C)水平及其与心肾功能的关系。方法选择2016年7月～2018年7月于四川省成都市第三人民医院就诊的CHF患者95例作为研究组,另外选择同期体检中心的健康志愿者68例作为对照组。采用酶联免疫吸附测定法检测血清中TNF-α、BNP及Cys-C水平,同时应用彩色多普勒超声仪监测受试者左室舒张末期内径(LVEDD),左室射血分数(LVEF)及左室质量指数(LVMI),另外检测患者肾功能相关指标水平,包括血肌酐(Scr)、血尿素氮(BUN)及肾小球滤过率(GFR),并分析血清生物学指标与心肾功能指标的相关性。结果研究组血清TNF-α、BNP、Cys-C、LVEDD、LVMI、Scr及BUN水平均显著高于对照组,LVEF和GFR显著低于对照组,差异有统计学意义(P <0.05)。随着心功能分级升高和肾功能损伤加重,CHF患者血清TNF-α、BNP及Cys-C水平明显升高,差异有统计学意义(P <0.05)。CHF患者血清TNF-α、BNP及Cys-C水平与LVEDD、LVMI、Scr及BUN呈正相关(P <0.05),而与LVEF和GFR呈负相关(P <0.05)。结论血清TNF-α、BNP及Cys-C水平上升与CHF患者心肾功能损伤程度密切相关,临床可以用于CHF的诊断及预后的评价。
Objective To investigate the level of serum tumor necrosis factor-α(TNF-α), brain natriuretic peptide(BNP) and cystatin-C(Cys-C) in patients with chronic heart failure(CHF) and their relationship with heart-kidney function. Methods Niney-five cases of patients with CHF in the Third People′s Hospital of Chengdu City in Sichuan Province from July 2016 to July 2018 were selected as study group, in addition, 68 cases of healthy volunteers in same physical examination center were selected as control group. Serum levels of TNF-α, BNP and Cys-C were measured by enzyme-linked immunosorbent assay, and left ventricular end-diastolic diameter(LVEDD), left ventricular ejection fraction(LVEF) and left ventricular mass index(LVMI) were measured by color Doppler ultrasonic unit. Renal function related indicators were also detected,included serum creatinine(Scr), blood urea nitrogen(BUN) and glomerular filtration rate(GFR). The correlation between serum biological indicators and heart-kidney function indexes was analyzed.Results The serum levels of TNF-α, BNP, Cys-C, LVEDD, LVMI, Scr and BUN in study group were significantly higher than those in control group, while the levels of LVEF and GFR in study group were significantly lower than those in control group, the differences were statistically significant(P < 0.05). With the increase of cardiac function and the aggravation of renal function, the levels of TNF-α, BNP and Cys-C of patients with CHF increased significantly, the differences were statistically significant(P < 0.05). The levels of TNF-α, BNP and Cys-C were positively correlated with LVEDD, LVMI, Scr and BUN(P < 0.05), but negatively correlated with LVEF and GFR(P < 0.05). Conclusion The elevation of serum TNF-α, BNP and Cys-C level is closely related to the cardiac function and the degree of renal injury in CHF patients. It can be used in clinical diagnosis and prognosis evaluation of CHF.
Objective To investigate the level of serum tumor necrosis factor-α(TNF-α), brain natriuretic peptide(BNP) and cystatin-C(Cys-C) in patients with chronic heart failure(CHF) and their relationship with heart-kidney function. Methods Niney-five cases of patients with CHF in the Third People′s Hospital of Chengdu City in Sichuan Province from July 2016 to July 2018 were selected as study group, in addition, 68 cases of healthy volunteers in same physical examination center were selected as control group. Serum levels of TNF-α, BNP and Cys-C were measured by enzyme-linked immunosorbent assay, and left ventricular end-diastolic diameter(LVEDD), left ventricular ejection fraction(LVEF) and left ventricular mass index(LVMI) were measured by color Doppler ultrasonic unit. Renal function related indicators were also detected,included serum creatinine(Scr), blood urea nitrogen(BUN) and glomerular filtration rate(GFR). The correlation between serum biological indicators and heart-kidney function indexes was analyzed.Results The serum levels of TNF-α, BNP, Cys-C, LVEDD, LVMI, Scr and BUN in study group were significantly higher than those in control group, while the levels of LVEF and GFR in study group were significantly lower than those in control group, the differences were statistically significant(P < 0.05). With the increase of cardiac function and the aggravation of renal function, the levels of TNF-α, BNP and Cys-C of patients with CHF increased significantly, the differences were statistically significant(P < 0.05). The levels of TNF-α, BNP and Cys-C were positively correlated with LVEDD, LVMI, Scr and BUN(P < 0.05), but negatively correlated with LVEF and GFR(P < 0.05). Conclusion The elevation of serum TNF-α, BNP and Cys-C level is closely related to the cardiac function and the degree of renal injury in CHF patients. It can be used in clinical diagnosis and prognosis evaluation of CHF.
引文
[1]吴振阳.BNP在慢性心力衰竭诊断、治疗及预后中的应用价值[J].中国医药指南,2016,14(15):13-14.
[2]李宾,刘静,黄红霞,等.Galectin-3和CysC水平与慢性心力衰竭患者心室重构及预后关系的研究[J].宁夏医科大学学报,2015,37(3):252-256.
[3]周熙琳,梁辉,陆英,等.老年慢性心力衰竭患者肿瘤坏死因子、脑钠肽水平变化及其相关性分析[J].现代生物医学进展,2014,14(8):1446-1448.
[4]王婧,柳达,罗文利,等.老年慢性心力衰竭患者胱抑素C和纤维蛋白原水平的变化趋势及意义[J].检验医学与临床,2015,12(5):616-618,621.
[5]许琴,淡利军.血浆BNP水平在慢性心衰患者诊疗中的价值研究[J].临床医学研究与实践,2016,1(26):35-36.
[6]宋暖.慢性心力衰竭患者血浆BNP、TNF-α及血脂水平的变化[J].中西医结合心血管病电子杂志,2016,4(18):53-54.
[7]张少利,王学惠,陈志刚,等.慢性心力衰竭患者血清胱抑素C水平与疾病严重程度及预后的相关性研究[J].解放军医药杂志,2017,29(3):46-48,56.
[8]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12):1076-1095.
[9]崔志远,曹慧,庞晓.慢性心力衰竭患者血清肿瘤坏死因子α水平变化及其与心肾功能的关系[J].山东医药,2016,56(17):66-68.
[10]何海潇.BNP检测对慢性心力衰竭患者的临床应用价值分析[J].吉林医学,2016,37(5):1116-1118.
[11]刘琼,蒋周田,秦天赐,等.BNP与HCY在慢性心力衰竭患者中表达变化及临床意义[J].河北医学,2016,22(6):961-962.
[12]山萌萌,王凤菊,庞晓,等.慢性心力衰竭合并肾功能不全相关危险因素分析[J].中国动脉硬化杂志,2017,25(6):604-609.
[13]Scrutinio D,Agostoni P,Gesualdo L,et al.Renal function and peak exercise oxygen consumption in chronic heart failure with reduced left ventricular ejection fraction[J].Circ J,2015,79(3):583-591.
[14]耿庆亚.老年慢性心力衰竭患者血清TNF-α和MMP-9等的检测水平及对预后判断的意义[J].浙江实用医学,2014,19(6):387-389,412.
[15]李志,刘平.心力衰竭患者短期预后应用BNP指导急性失代偿性心力衰竭治疗的效果分析[J].中国医药指南,2015,13(10):20-21.
[16]吴晓东,齐新,侯文广,等.慢性心力衰竭患者血清胱抑素C水平变化及临床意义[J].天津医药,2015,43(10):1162-1165.
[17]Ho LC,Sung JM,Tsai YS,et al.Cystatin C as a predictor for outcomes in patients with negligible renal function[J].Blood Purif,2014,38(2):81-88.
[18]马立庆,段保湘,赵静惠,等.慢性心力衰竭患者肿瘤坏死因子-α与心功能的关系分析[J].现代医药卫生,2016,32(2):246-247.
[19]李金英.慢性心衰患者血浆脑钠肽检测的临床价值[J].医学理论与实践,2017,30(5):740-742.
[20]朱平,冯青俐,姚爱琴.慢性心力衰竭伴肾功能不全患者与血浆脑钠肽水平相关性的临床研究[J].临床荟萃,2011,26(16):1422-1423.
[21]Aumann N,Baumeister SE,Werner A,et al.Inverse association of estimated cystatin C-and creatinine-based glomerular filtration rate with left ventricular mass:results from the study of health in pomerania[J].Int JCardiol,2013,167(6):2786-2791.
[2]李宾,刘静,黄红霞,等.Galectin-3和CysC水平与慢性心力衰竭患者心室重构及预后关系的研究[J].宁夏医科大学学报,2015,37(3):252-256.
[3]周熙琳,梁辉,陆英,等.老年慢性心力衰竭患者肿瘤坏死因子、脑钠肽水平变化及其相关性分析[J].现代生物医学进展,2014,14(8):1446-1448.
[4]王婧,柳达,罗文利,等.老年慢性心力衰竭患者胱抑素C和纤维蛋白原水平的变化趋势及意义[J].检验医学与临床,2015,12(5):616-618,621.
[5]许琴,淡利军.血浆BNP水平在慢性心衰患者诊疗中的价值研究[J].临床医学研究与实践,2016,1(26):35-36.
[6]宋暖.慢性心力衰竭患者血浆BNP、TNF-α及血脂水平的变化[J].中西医结合心血管病电子杂志,2016,4(18):53-54.
[7]张少利,王学惠,陈志刚,等.慢性心力衰竭患者血清胱抑素C水平与疾病严重程度及预后的相关性研究[J].解放军医药杂志,2017,29(3):46-48,56.
[8]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南[J].中华心血管病杂志,2007,35(12):1076-1095.
[9]崔志远,曹慧,庞晓.慢性心力衰竭患者血清肿瘤坏死因子α水平变化及其与心肾功能的关系[J].山东医药,2016,56(17):66-68.
[10]何海潇.BNP检测对慢性心力衰竭患者的临床应用价值分析[J].吉林医学,2016,37(5):1116-1118.
[11]刘琼,蒋周田,秦天赐,等.BNP与HCY在慢性心力衰竭患者中表达变化及临床意义[J].河北医学,2016,22(6):961-962.
[12]山萌萌,王凤菊,庞晓,等.慢性心力衰竭合并肾功能不全相关危险因素分析[J].中国动脉硬化杂志,2017,25(6):604-609.
[13]Scrutinio D,Agostoni P,Gesualdo L,et al.Renal function and peak exercise oxygen consumption in chronic heart failure with reduced left ventricular ejection fraction[J].Circ J,2015,79(3):583-591.
[14]耿庆亚.老年慢性心力衰竭患者血清TNF-α和MMP-9等的检测水平及对预后判断的意义[J].浙江实用医学,2014,19(6):387-389,412.
[15]李志,刘平.心力衰竭患者短期预后应用BNP指导急性失代偿性心力衰竭治疗的效果分析[J].中国医药指南,2015,13(10):20-21.
[16]吴晓东,齐新,侯文广,等.慢性心力衰竭患者血清胱抑素C水平变化及临床意义[J].天津医药,2015,43(10):1162-1165.
[17]Ho LC,Sung JM,Tsai YS,et al.Cystatin C as a predictor for outcomes in patients with negligible renal function[J].Blood Purif,2014,38(2):81-88.
[18]马立庆,段保湘,赵静惠,等.慢性心力衰竭患者肿瘤坏死因子-α与心功能的关系分析[J].现代医药卫生,2016,32(2):246-247.
[19]李金英.慢性心衰患者血浆脑钠肽检测的临床价值[J].医学理论与实践,2017,30(5):740-742.
[20]朱平,冯青俐,姚爱琴.慢性心力衰竭伴肾功能不全患者与血浆脑钠肽水平相关性的临床研究[J].临床荟萃,2011,26(16):1422-1423.
[21]Aumann N,Baumeister SE,Werner A,et al.Inverse association of estimated cystatin C-and creatinine-based glomerular filtration rate with left ventricular mass:results from the study of health in pomerania[J].Int JCardiol,2013,167(6):2786-2791.