慢性心力衰竭患者心脏再同步化治疗后炎症因子的改变
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摘要
目的:探讨慢性心力衰竭患者心脏再同步化治疗(CRT)前后血清炎症因子肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)和白细胞介素-27 (IL-27)水平的变化.方法:选取70例慢性心力衰竭患者,分为联合治疗组和单纯药物组各35例,其中单纯药物组行优化药物治疗,联合治疗组在此基础上行CRT治疗.比较两组治疗前以及治疗后3个月血清TNF-α、IL-1和IL-27水平及左室射血分数(LVEF)、左室舒张末期内径(LVEDd)及左室质量指数(LVMI)的变化.结果:两组治疗后TNF-α、IL-1和均明显下降,IL-27明显升高,且联合治疗组变化较单纯药物组更显著(P<0.05),两组LVEDd、LVEF及LVMI均优于治疗前,且联合治疗组优于单纯药物组,有统计学差异(P<0.05).结论:慢性心力衰竭患者CRT治疗后,炎症因子水平及心功能均得到改善.TNF-α、IL-1和IL-27水平指标可以作为评价CRT效果的指标之一.
Objective:To analyze the change of serum inflammatory cytokines TNF-α, IL-1 and IL-27 before and after cardiac resynchronization therapy(CRT)in patients with chronic heart failure(CHF). Methods: Seventy patients with chronic heart failure were divided into combined treatment group and simple drug group, 35 cases in each group. In simple drug group, the patients were treated only with the optimal drug therapy, while the patients were given the optimal drug therapy together with CRT in combined treatment group. The levels of TNF-α, IL-1, IL-27 and cardiac function indexes in patients before and after 3 months of treatment were recorded and compared. Results: After 3 months, both groups showed obvious decrease in TNF-α and IL-1 level and increase in IL-27 level, and the change in combined group was more significant than in simple drug group(P<0.05). The left ventricular end-diastolic dimension, left ventricular ejection fraction and left ventricular mass index in both groups were better than those before treatment, and the combined group was better than simple drug group with statistical significance(P<0.05). Conclusion: After CRT treatment, the level of inflammatory factors and cardiac function indexes in patients with CHF was improved. The level of TNF-α, IL-1 and IL-27 can be used as one of the indicators for evaluating the effect of CRT.
Objective:To analyze the change of serum inflammatory cytokines TNF-α, IL-1 and IL-27 before and after cardiac resynchronization therapy(CRT)in patients with chronic heart failure(CHF). Methods: Seventy patients with chronic heart failure were divided into combined treatment group and simple drug group, 35 cases in each group. In simple drug group, the patients were treated only with the optimal drug therapy, while the patients were given the optimal drug therapy together with CRT in combined treatment group. The levels of TNF-α, IL-1, IL-27 and cardiac function indexes in patients before and after 3 months of treatment were recorded and compared. Results: After 3 months, both groups showed obvious decrease in TNF-α and IL-1 level and increase in IL-27 level, and the change in combined group was more significant than in simple drug group(P<0.05). The left ventricular end-diastolic dimension, left ventricular ejection fraction and left ventricular mass index in both groups were better than those before treatment, and the combined group was better than simple drug group with statistical significance(P<0.05). Conclusion: After CRT treatment, the level of inflammatory factors and cardiac function indexes in patients with CHF was improved. The level of TNF-α, IL-1 and IL-27 can be used as one of the indicators for evaluating the effect of CRT.
引文
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[11] 邬涛, 吴清华,吴丹,等. 慢性心力衰竭患者外周血NF-кB、血清TGF-β1与心室重构的相关性[J]. 重庆医学, 2016, 45(24): 3408-3411. WU T, WU Q H, WU D, et al. Correlation between peripheral blood NF-кB/ TGF-β1 and ventricular remodeling in patients with chronic heart failure[J]. Chongqing Medical Journal, 2016, 45(24): 3408-3411.
[12] 陈冰,李志操,靳文,等. 慢性心力衰竭患者外周血白介素-27与树突状细胞亚群变化的研究[J]. 中国实用内科杂志, 2014, 34(9): 888-891. CHEN B, LI Z C, JIN W, et al. Changes in the Levels of IL-27 and dendritic cell sub-population in peripheral blood of patients with chronic heart failure[J].Chinese Journal of Practical Internal Medcine, 2014, 34(9): 888-891.
[13] 周建松,高翔,张小兵,等. 慢性心力衰竭患者外周血白介素-27 临床意义研究[J].中国临床医生杂志, 2017, 45(11): 32-34. ZHOU J S, GAO X, ZHANG X B, et al. Clinical significance of interleukin-27 in peripheral blood in patients with chronic heart failure[J]. Chinese Journal for Clinicians, 2017, 45(11): 32-34.
[14] 杨玉春,周晓欢,木胡牙提,等. 心脏再同步治疗对中重度慢性心力衰竭的疗效研究[J].中国循环杂志,2014,29(3):194-197. YANG Y C, ZHOU X H, MUHU Y T, et al. Effect of cardiac resynchronization therapy in patients with moderate to severe chronic heart failure[J]. Chinese Circulation Journal, 2014,29(3): 194-197.
[15] 李朋, 李睿, 杨海珍, 等. 心脏再同步化治疗对慢性心力衰竭患者炎症反应和心室重构的影响[J]. 心血管康复医学杂志, 2016, 25(6):613-616. LI P,LI R,YANG H Z, et al. Influence of cardiac resynchronization on inflammation and ventricular remodeling in patients with chronic heart failure[J]. Chin J Cardiovasc Rehabil Med, 2016, 25(6):613-616.
[16] SLIWA K, SKUDICKY D, CANDY G, et al. Randomised investigation of effects of pentoxifylline o left-ventricular performance in idiopathic dilated cardiomyopathy[J]. Lancet, 1998, 351(9109):1091-1093.
[17] SHAW S M, SHAH M K, WILLIAMS S G, et al. Immunological mechanisms of pentoxifylline in chronic heart failure[J]. Eur J Heart Fail, 2009,11(2): 113-118.
[2] DEMISSEI B G, VALENTE M A, CLELAND J G, et al. Optimizing clinical use of biomarkers in high-risk acute heart failure patients[J]. Eur J Heart Fail, 2016, 18(3):269-280.
[3] DROZD M, GIERULA J, LOWRY J E, et al. Cardiac resynchronization therapy outcomes in patients with chronic heart failure: cardiac resynchronization therapy with pacemaker versus cardiac resynchronization therapy with defibrillator[J]. J Cardiovasc Med (Hagerstown), 2017, 18(12): 962-967.
[4] GORZIN F, AMIRZARGAR A A, MAHMOUDI M J, et al. FOXP3, RORgammat and IL-10 cytokine profile in chronic heart failure[J]. Bratisl Lek Listy, 2017, 118(10): 637-641.
[5] ZHANG F,DANG Y,LI Y,et al. Cardiac contractility modulation attenuate myocardial fibrosis by inhibiting tgf-beta1/smad3 signaling pathway in a rabbit model of chronic heart failure[J]. Cell Physiol Biochem, 2016,39(1):294-302.
[6] RAJAGOPALAN V, GERDES A M. Role of thyroid hormones in ventricular remodeling[J]. Curr heart Fail Rep, 2015,12(2): 141-149.
[7] STANCIU A E,VATASESCU R G,STANCIU M M,et al. Cardiac resynchronization therapy in patients with chronic hear t failure is associated with anti-inflammatory and anti- remodeling effects[J]. Clin Biochem, 2013, 46(3): 230-234.
[8] NIAN M,LEE P,KHAPER N,et al. Inflammatory cytokines and postmyocardial infarction remodeling[J]. Circ Res, 2012, 94(32): 1543-1553.
[9] TSAROUHAS K, TSITSIMPIKOU C, HALIASSOS A, et al. Study of insulin resistance, TNF-alpha, total antioxidant capacity and lipid profile in patients with chronic heart failure under exercise[J]. In Vivo, 2011, 25(6): 1031-1037.
[10] CONRAADS V M, DENOLLET J, DE CLERCK L S, et al. Type D personality is associated with increased levels of tumour necrosis factor (TNF)-alpha and TNF-alpha receptors in chronic heart failure[J]. Int J Cardiol, 2006, 113(1): 34-38.
[11] 邬涛, 吴清华,吴丹,等. 慢性心力衰竭患者外周血NF-кB、血清TGF-β1与心室重构的相关性[J]. 重庆医学, 2016, 45(24): 3408-3411. WU T, WU Q H, WU D, et al. Correlation between peripheral blood NF-кB/ TGF-β1 and ventricular remodeling in patients with chronic heart failure[J]. Chongqing Medical Journal, 2016, 45(24): 3408-3411.
[12] 陈冰,李志操,靳文,等. 慢性心力衰竭患者外周血白介素-27与树突状细胞亚群变化的研究[J]. 中国实用内科杂志, 2014, 34(9): 888-891. CHEN B, LI Z C, JIN W, et al. Changes in the Levels of IL-27 and dendritic cell sub-population in peripheral blood of patients with chronic heart failure[J].Chinese Journal of Practical Internal Medcine, 2014, 34(9): 888-891.
[13] 周建松,高翔,张小兵,等. 慢性心力衰竭患者外周血白介素-27 临床意义研究[J].中国临床医生杂志, 2017, 45(11): 32-34. ZHOU J S, GAO X, ZHANG X B, et al. Clinical significance of interleukin-27 in peripheral blood in patients with chronic heart failure[J]. Chinese Journal for Clinicians, 2017, 45(11): 32-34.
[14] 杨玉春,周晓欢,木胡牙提,等. 心脏再同步治疗对中重度慢性心力衰竭的疗效研究[J].中国循环杂志,2014,29(3):194-197. YANG Y C, ZHOU X H, MUHU Y T, et al. Effect of cardiac resynchronization therapy in patients with moderate to severe chronic heart failure[J]. Chinese Circulation Journal, 2014,29(3): 194-197.
[15] 李朋, 李睿, 杨海珍, 等. 心脏再同步化治疗对慢性心力衰竭患者炎症反应和心室重构的影响[J]. 心血管康复医学杂志, 2016, 25(6):613-616. LI P,LI R,YANG H Z, et al. Influence of cardiac resynchronization on inflammation and ventricular remodeling in patients with chronic heart failure[J]. Chin J Cardiovasc Rehabil Med, 2016, 25(6):613-616.
[16] SLIWA K, SKUDICKY D, CANDY G, et al. Randomised investigation of effects of pentoxifylline o left-ventricular performance in idiopathic dilated cardiomyopathy[J]. Lancet, 1998, 351(9109):1091-1093.
[17] SHAW S M, SHAH M K, WILLIAMS S G, et al. Immunological mechanisms of pentoxifylline in chronic heart failure[J]. Eur J Heart Fail, 2009,11(2): 113-118.