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目的:研究慢性充血性心力衰竭(CHF)贫血患者血清肿瘤坏死因子-α(TNF-α)、B型钠尿肽(BNP)水平与心室重构的关系及干预。方法:检测入选的319例CHF患者的血红蛋白、血清TNF-α和血浆BNP水平,行UCG测量左心室射血分数(LVEF),计算平均室壁应力(MWS);按血红蛋白水平分为CHF贫血组和非贫血组。结果:随着CHF患者心功能的恶化,其血红蛋白水平逐渐降低,而血清TNF-α和血浆BNP水平以及MWS和LVMI则逐渐升高;CHF贫血组的血清TNF-α和血浆BNP水平以及MWS和LVMI均明显高于CHF非贫血组(均为P<0.01);CHF患者MWS和LVMI与血红蛋白水平呈负相关,与血浆BNP、TNF-α水平呈正相关(P<0.01)。治疗后的结果显示,CHF贫血患者在贫血纠正后,血清TNF-α、BNP以及MWS恢复到非贫血组患者水平。结论:CHF患者贫血和TNF-α水平的升高参与了CHF心室重构发生发展的病理生理过程,纠正贫血,规范治疗可显著降低血清TNF-α,MWS和LVMI减轻至血浆BNP水平降低,从而改善CHF患者心脏功能和预后。
Objective: To investigate the relationship between serum TNF-α, BNP and ventricular remodeling in patients with chronic congestive heart failure (CHF) and its intervention. Methods: The levels of hemoglobin, serum TNF-α and plasma BNP in 319 CHF patients were measured. Left ventricular ejection fraction (LVEF) was measured by UCG to calculate the average wall stress (MWS). According to hemoglobin level, And non-anemia group. Results: With the deterioration of cardiac function in CHF patients, the levels of hemoglobin gradually decreased while the levels of serum TNF-α and plasma BNP, MWS and LVMI gradually increased. The levels of TNF-α and plasma BNP, LVMI were significantly higher than those of non-anemia group (all P <0.01). MWS and LVMI of CHF patients were negatively correlated with hemoglobin level and positively correlated with plasma BNP and TNF-α levels (P <0.01). Results after treatment showed that serum TNF-α, BNP and MWS were restored to non-anemia patients after CHF correction in patients with anemia. CONCLUSIONS: Anemia and TNF-α levels in CHF patients are involved in the pathophysiological process of ventricular remodeling in CHF, which can correct anemia. Standardized treatment can significantly reduce the reduction of serum TNF-α, MWS and LVMI to decrease plasma BNP level, thus Improve cardiac function and prognosis in CHF patients.