静息心率与慢性心力衰竭患者炎症因子及血脑钠肽的关系

摘要

目的 探讨慢性心力衰竭(CHF)患者入院时静息心率与炎症因子及血脑钠肽(BNP)的关系.方法 选择2015年1月至2016年6月在上海市浦东医院心血管内科住院的180例纽约心脏学会(NYHA)心功能分级Ⅱ～Ⅳ级的CHF患者,按静息心率将患者分为A组(心率≤70次/min)56例,B组(心率:70～90次/min)76例,C组(心率>90次/min)48例;患者入院时检测炎症因子C-反应蛋白(CRP)、白介素-1β(IL-1β)、白介素-6(IL-6)、肿瘤坏死因子α(TNF-α),血浆BNP水平以及左室射血分数(LVEF),比较各组患者相关指标的差异.结果 三组患者在炎症因子、血清BNP水平及LVEF方面比较差异均有显著统计学意义(P<0.01);C组患者与A组和B组的CRP[(8.52±0.49)mg/L vs(5.87±0.46)mg/L vs(6.94±0.57)mg/L]、IL-1β[(29.2±3.3)pg/mL vs(16.6±2.7)pg/mL vs(22.7±2.9)pg/mL]、IL-6[(109.6±11.8)ng/L vs(80.2±9.8)ng/L vs(97.8±12.4)ng/L]、TNF-α[(65.8±12.9)ng/mL vs(33.6±6.8)ng/mL vs(45.8±8.1)ng/mL]及BNP[(962±106.4)pg/mL vs(595±68.9)pg/mL vs(726±98.3)pg/mL]水平比较,C组明显高于A组和B组,而LVEF[(38.1±6.8)％vs(49.2±5.9)％vs(43.6±5.6)％比较,C组明显低于A组和B组,差异均有统计学意义(P<0.05);与A组比较,B组患者的CRP、IL-1β 、IL-6、TNF-α 及BNP水平明显增高,LVEF明显偏低,差异均有统计学意义(P<0.05);Pearson相关分析显示,所有CHF患者的静息心率与CRP、IL-1β、IL-6、TNF-α及BNP呈正相关(r分别为0.305、0.297、0.319、0.331和0.562,P<0.05),与LVEF呈负相关(r=-0.345,P<0.05).结论 静息心率水平与慢性心力衰竭患者炎症因子及BNP水平呈正相关,与LVEF呈负相关.%Objective To evaluate the relationships of resting heart rate with inflammatory factors and brain na-triuretic peptide (BNP) concentration in patients with chronic heart failure (CHF). Methods From January 2015 to June 2016, A total of 180 CHF patients in New York Heart Association (NYHA) functional class Ⅱ-Ⅳ, who admitted to Department of Cardiology of Shanghai Pudong Hospital, were enrolled and divided into the group A (≤70 beats/min, n=56), group B (70-90 beats/min, n=76) and group C (>90 beats/min, n=48) according to resting heart rates. The concentra-tion of C-reaction protein (CRP), interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), BNP, left ventricular ejection fracetion (LVEF) at admission were measured and compared. Results There were significant differ-ences between the three groups in inflammatory factors, serum BNP level and LVEF. The levels of CRP, IL-1 β, IL-6, TNF-α, and BNP in the group C were (8.52±0.49) mg/L, (29.2±3.3) pg/mL, (109.6±11.8) ng/L, (65.8±12.9) ng/mL, (962± 106.4) pg/mL, respectively, which were significantly higher than (5.87±0.46) mg/L, (16.6±2.7) pg/mL, (80.2±9.8) ng/L, (33.6±6.8) ng/mL, (595±68.9) pg/mL in the group A and (6.94±0.57) mg/L, (22.7±2.9) pg/mL, (97.8±12.4) ng/L], (45.8± 8.1) ng/mL, (726±98.3) pg/mL in the group B (P<0.01). While, the LVEF in the group C was (38.1±6.8)％, which was significantly lower than (49.2±5.9)％ in the group A and (43.6±5.6)％ in the group B (P<0.01). Compared with the group A, the levels of CRP, IL-1β, IL-6, TNF-α and BNP were significantly increased, but LVEF was significantly decreased (P<0.05). Pearson's correlation analysis revealed that resting heart rate had positive correlation with CRP (r=0.305, P<0.05), IL-1β (r=0.297, P<0.05), IL-6 (r=0.319, P<0.05), TNF-α (r=0.331, P<0.05) and BNP levels (r=0.562, P<0.05), and negative correlation with LVEF (r=-0.345, P<0.05). Conclusion In the patients with CHF, resting heart rate is posi-tively correlated with inflammatory factors and BNP levels, and negatively correlated with LVEF.