比索洛尔对充血性心力衰竭患者促炎性和抗炎性细胞因子的影响

Effect of Bisoprolol on Pro-inflammatory and Anti-inflammatory in Patients with Congestive Heart Failure

关键词:  充血性心力衰竭  比索洛尔  白介素-6  白介素-10  肿瘤坏死因子-α

Key words:  congestive heart failure  bisoprolol  interleukin-6  interleukin-10  tumor necrosis factor-alpha

摘要:

目的 探讨慢性心力衰竭(congestive heart failure，CHF)患者血清中促炎性细胞因子和抗炎性细胞因子水平的变化，及比索洛尔干预治疗对细胞因子、心功能及运动耐量的影响。方法 选择100例CHF患者(心衰组)及50例无心脏病的健康体检者(对照组)，检测血清中白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、白介素-10(IL-10)水平。并将心衰组随机分为常规治疗组和比索洛尔组进行临床干预，随访12周。随访前及12周后均检测血清IL-6、IL-10和TNF-α水平、心脏超声及6 min步行试验(six-minute hall walk test，6 WT)。结果 心衰组血清细胞因子水平均显著高于正常对照组(P<0.01)；比索洛尔组治疗后血清IL-6、TNF-α水平显著下降(P<0.05)，IL-10有上升趋势；心脏超声除左室舒张末期内径外各项指标均显著改善；而常规治疗组治疗后仅左室射血分数和缩短分数改善，细胞因子水平无显著变化；比索洛尔组治疗后IL-6水平与常规治疗组比较有显著差异(P<0.05)；比索洛尔组6 WT有所改善，且与对照组治疗后比较，比索洛尔组治疗后6 WT改善更明显。结论 CHF患者促炎性细胞因子分泌增加而抗炎性细胞因子分泌绝对或(和)相对不足，对CHF的发生和发展具有重要影响。比索洛尔能降低促炎性细胞因子浓度，升高抗炎性细胞因子浓度，这可能是其改善心脏功能，抑制左室重构的机制之一。

Abstract:

OBJECTIVE To investigate the levels of serum concentrations of interleukin-6(IL-6), tumor necrosis factor-alpha(TNF-α) and interleukin-10(IL-10) in patients with congestive heart failure (CHF), and to evaluate the beneficial effects of bisoprolol on the above variables, cardiac function and exercise endurance. METHODS One hundred patients with CHF(CHF group) and fifty healthy physical examinees(control group) were selected. The serum levels of IL-6, IL-10 and TNF-α were measured. Patients with CHF were divided randomly into conventional treatment group and bisoprolol group (routine drugs additional bisoprolol) and followed up for 12 weeks. The serum levels of IL-6, IL-10 and TNF-α and cardiac function and six-minute hall walk test were measured pre-treatment and after treatment. RESULTS The main findings in the CHF group were as follows: the serum levels of IL-6, IL-10 and TNF-α were significantly higher than those in the control group (P<0.01); the serum levels of IL-6, IL-10 and TNF-α were positively correlated to each other; the ratios of IL-6/IL-10 and TNF-α/IL-10 increased with increasing the severity of CHF (P<0.05); the serum levels of IL-6 and TNF-α were significantly decreased, and the serum level of IL-10 showed a rising trend after treatment as compared with before treatment in the bisoprolol group; the left ventricular ejection fraction (LVEF), fractional shortening (FS) and cardiac output (CO) were significantly increased in the bisoprolol group, but in the control group, only LVEF and FS were improved, while cytokine levels showed no change. Six-minutes walking distance of the paitents in the bisoprolol group were increased signifcantly. CONCLUSION The cytokines were out of balance in the patients with CHF. These disorders were related to the abnormal secretion of inflammatory cytokines. Bisoprolol could improve cardiac function and reduce inflammatory cytokine plasma level in patients with CHF. It might be one of the new mechanisms to improve cardiac function and reverse myocardial remodeling.