【作者】 李旭；

【导师】 刘春；

【作者基本信息】 石河子大学 ， 内科学， 2015， 硕士

【摘要】 目的:探讨连续性血液净化(continuous blood purification,CBP)对顽固性心衰患者血浆炎症因子的影响。方法:选取2013年3月-2015年2月在新疆石河子市人民医院住院的顽固性心衰患者40例,根据患者意愿,给予常规药物治疗(对照组,n=20)或常规药物+CBP治疗(试验组,n=20)。治疗8小时,观察治疗前后血浆肿瘤坏死因子α(tumor necrosis factor alpha,TNF-α)、白细胞介素6(interleukin 6,IL-6)、白细胞介素8(interleukin 8,IL-8)、C反应蛋白(C-reactive protein,CRP)、纽约心脏病协会(New York Heart Association,NYHA)心功能分级的变化;使用治疗前数值减去治疗8h后数值,计算出上述炎症因子水平的变化量(ΔTNF-α、ΔIL-6、ΔIL-8、ΔCRP)及NYHA心功能分级变化量(ΔNYHA);分析ΔTNF-α、ΔIL-6、ΔIL-8、ΔCRP与ΔNYHA之间的相关性。结果:治疗前对照组TNF-α为(12.82±4.86)pg/ml,IL-6为(19.68±10.17)pg/ml、IL-8为(29.89±13.66)pg/ml、CRP为(21.35±8.78)mg/L,试验组TNF-α为(12.13±5.14)pg/ml、IL-6为(18.55±10.50)pg/ml、IL-8为(29.50±13.01)pg/ml、CRP为(20.37±8.91)mg/L,两组各炎症因子之间比较差异无统计学意义(P>0.05)。治疗8小时后:对照组TNF-α为(12.81±2.22)pg/ml、IL-6为(19.52±7.43)pg/ml、IL-8为(29.82±6.58)pg/ml、CRP为(21.25±8.01)mg/L,各炎症因子水平与治疗前比较差异无统计学意义(P>0.05);试验组TNF-α为(9.81±2.50)pg/ml、IL-6为(11.41±6.08)pg/ml、IL-8为(21.50±7.47)pg/ml、CRP为(15.45±8.07)mg/L,各炎症因子水平较治疗前下降(P<0.01);试验组TNF-α、IL-6、IL-8、CRP水平均低于对照组(P<0.05)。治疗前两组患者NYHA心功能分级均为Ⅳ级。治疗8小时后:对照组达到Ⅱ级0例,Ⅲ级3例,Ⅳ级17例;试验组达到Ⅱ级1例,Ⅲ级12例,Ⅳ级7例;试验组NYHA心功能分级改善优于对照组(P<0.001)。试验组治疗8h后血浆炎症因子水平下降值(ΔTNF-α、ΔIL-6、ΔIL-8、ΔCRP)、NYHA心功能分级改善级别数(ΔNYHA)均高于对照组(P<0.05)。Spearman相关分析显示,对照组ΔTNF-α、ΔIL-6、ΔIL-8、ΔCRP与ΔNYHA无相关性(P>0.05),试验组ΔTNF-α(rs=0.638,P=0.002)、ΔIL-6(rs=0.555,P=0.011)、ΔIL-8(rs=0.464,P=0.039)、ΔCRP(rs=0.589,P=0.006)与ΔNYHA呈正相关。结论:连续性血液净化+常规药物治疗能降低顽固性心衰患者血浆TNF-α、IL-6、IL-8、CRP水平,改善心功能;上述炎症因子水平下降与心功能改善呈正相关。更多还原

【Abstract】 Object: To investigate the effects of the levels of inflammatory cytokines in patients with refractory heart failure treated by continuous blood purification(CBP).Methods: Forty patients with refractory heart failure were enrolled from March 2013 to February 2015 in Shihezi People’s Hospital, and assigned into conventional medical treatment group(the control group, n=20) or CBP combined with conventional medical treatment group(the experimental group, n=20) according to the patient’s preferences.Before and after 8 hours of treatment,the levels of tumor necrosis factor alpha(TNF-α), interleukin 6(IL-6), interleukin 8(IL-8) and C-reactive protein(CRP) were determined,and the chang of New York Heart Association(NYHA) functional class was observed. The changes of these indicators(ΔTNF-α, ΔIL-6, ΔIL-8, ΔCRP, ΔLVEF) were calculated by the values before and after 8 hours of treatment.The correlation between ΔTNF-α, ΔIL-6, ΔIL-8, ΔCRP and ΔLVEF were evaluated.Results: Before treatment, the level of TNF-α was(12.82±4.86)pg/mL, IL-6 was(19.68±10.17)pg/m L, IL-8 was(29.89±13.66)pg/m L, CRP was(21.35±8.78)mg/L in the control group, and the level of TNF-α was(12.13±5.14)pg/m L, IL-6 was(18.55±10.50)pg/m L, IL-8 was(29.50±13.01)pg/m L, CRP was(20.37±8.91)mg/L in the experimental group, and there was no statistical significance between two groups for these indicators(P>0.05). After 8 hours of treatment, the level of TNF-α was(12.81±2.22)pg/m L, IL-6 was(19.52±7.43)pg/m L, IL-8 was(29.82±6.58)pg/m L,CRP was(21.25±8.01)mg/L in the control group,without statistical significance compared with the initial values(P>0.05).The level of TNF-α was(9.81±2.50)pg/m L, IL-6 was(11.41±6.08)pg/m L, IL-8 was(21.50±7.47)pg/m L, CRP was(15.45±8.07)mg/L in the experimental group, and lower than the initial values(P<0.01). The levels of TNF-α, IL-6, IL-8 and CRP in the experimental group were lower than the control group(P<0.05). All patients with NYHA functional class IV before treatment.After 8 hours of treatment, there were 0 case with class Ⅱ, 3 cases with class Ⅲ and 17 cases with class IV in contol group,and one case with class Ⅱ, 12 cases with class Ⅲ and 7 cases with class IV in the experimental group. Improvement in NYHA functional class in the experimental group was more than the conventional group(P<0.001).After 8 hours of treatment, the decreased level of inflammatory cytokines(ΔTNF-α、ΔIL-6、ΔIL-8、ΔCRP) and the improvement of NYHA functional class(ΔNYHA) in the experimental group were higher than those in the control group(P<0.05). Spearman correlation analysis showed no correlation between ΔTNF-α、ΔIL-6、ΔIL-8、ΔCRP and ΔNYHA in the control group(P>0.05),and positive correlation between ΔTNF-α(rs=0.638,P=0.002)、ΔIL-6(rs=0.555,P=0.011)、ΔIL-8(rs=0.464,P=0.039)、ΔCRP(rs=0.589,P=0.006) and ΔNYHA in the experimental group.Conclusion: CBP combined with conventional medical treatment reduced the plasma concentration of TNF-α, IL-6, IL-8 and CRP, and improved cardiac function in patients with refractory heart failure. The decreased level of these inflammatory cytokines were positively correlated with the improvement of cardiac function.更多还原