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目的:研究血清肿瘤坏死因子α(TNF-α)、血管紧张素Ⅱ(AngⅡ)在慢性心力衰竭(CHF)患者血红蛋白水平变化中的作用,探讨肾素-血管紧张素系统、炎症细胞因子、血红蛋白水平变化与心室重构的关系。方法:对入选的121例CHF患者测定了血红蛋白、血清TNF-α和AngⅡ水平,超声心动图测量左室射血分数(LVEF),评价心功能;计算左心室质量指数(LVMI)和室壁应力(MWS);按血红蛋白水平将CHF分为贫血组和非贫血组,同时选择27例正常人作为对照组。结果:CHF患者Hb水平低于正常对照组,而血清TNF-α和AngⅡ水平以及MWS和LVMI高于对照组(P<0.01);随着心功能恶化,Hb水平逐渐降低,而血清TNF-α和AngⅡ水平以及MWS和LVMI逐渐升高;CHF贫血组患者血清TNF-α和AngⅡ水平以及MWS和LVMI明显高于非贫血组患者(P<0.01);随着Hb水平降低,CHF患者血清TNF-α和AngⅡ水平以及MWS和LVMI明显升高(P<0.01);CHF患者MWS和LVMI与Hb水平呈负相关,与TNF-α、AngⅡ水平呈正相关(P<0.01)。结论:CHF患者TNF-α和AngⅡ水平的升高参与了CHF贫血和心室重构发生发展的病理生理过程,而CHF患者贫血的出现使CHF心室重构加重。
Objective: To investigate the role of serum tumor necrosis factor α (TNF-α) and angiotensin Ⅱ (Ang Ⅱ) in the changes of hemoglobin in patients with chronic heart failure (CHF) and to explore the relationship between renin-angiotensin system, inflammatory cytokines, hemoglobin Relationship between changes of level and ventricular remodeling. Methods: The hemoglobin, serum TNF-α and AngⅡ levels were measured in 121 CHF patients. The left ventricular ejection fraction (LVEF) was measured by echocardiography and the cardiac function was evaluated. The left ventricular mass index (LVMI) MWS). According to the level of hemoglobin, CHF was divided into anemia group and non-anemia group, 27 normal individuals were selected as control group. Results: The levels of Hb in CHF patients were lower than those in normal controls, while the serum levels of TNF-α and AngⅡ, MWS and LVMI were higher than those in control group (P <0.01) (P <0.01). The level of serum TNF-α, AngⅡ, MWS and LVMI in patients with CHF anemia were significantly higher than those in non-anemia patients (P <0.01) (P <0.01). MWS and LVMI in CHF patients were negatively correlated with Hb levels and positively correlated with TNF-α and AngⅡ levels (P <0.01). CONCLUSIONS: Elevated TNF-α and AngⅡ levels in CHF patients are involved in the pathophysiological process of development of CHF anemia and ventricular remodeling, whereas the presence of anemia in CHF patients aggravates CHF ventricular remodeling.