Clark D J, Cleman M W, Pfau S E, Rollins S A, Ramahi T M, Mayer C, Caulin-Glaser T, Daher E, Kosiborod M, Bell L, Setaro J F
Section of Cardiovascular Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
Am Heart J. 2001 Apr;141(4):684-90. doi: 10.1067/mhj.2001.113758.
Although activation of the complement system in myocardial infarction and cardiopulmonary bypass has been shown to contribute to myocardial injury, its role in congestive heart failure (CHF) is unknown. The purpose of this study was to determine the presence of terminal complement activation and its relation to clinical outcomes in patients with CHF.
We measured serum levels of the terminal complement complex C5b-9 in 36 patients with symptomatic heart failure and left ventricular ejection fraction <40%. We compared the serum C5b-9 levels of these patients with CHF with a group of 12 age-matched control patients. Combined clinical outcomes (death, urgent heart transplantation, or hospitalization with worsening heart failure) at 6 months were determined.
The serum C5b-9 [median (25th to 75th percentiles)] levels in 36 patients with CHF [101.5 ng/mL (40 to 164)] were significantly (P =.003) higher than in the 12 control patients [36.5 ng/mL (22 to 50)]. Significantly more of the patients with CHF with the highest levels of C5b-9 (highest 50th percentile) had New York Heart Association class IV symptoms (67% vs 33%; P =.04) and adverse clinical outcomes by 6 months (56% vs 17%; P =.02) compared with the patients with CHF with lower levels (lowest 50th percentile).
We have described a significant elevation in circulating C5b-9, the terminal complement complex, in patients with symptomatic heart failure and have observed an association between high levels of C5b-9 and near-term adverse events.
尽管已表明补体系统在心肌梗死和体外循环中的激活会导致心肌损伤，但其在充血性心力衰竭（CHF）中的作用尚不清楚。本研究的目的是确定终末补体激活的存在及其与CHF患者临床结局的关系。
我们测量了36例有症状心力衰竭且左心室射血分数<40%患者的血清终末补体复合物C5b-9水平。我们将这些CHF患者的血清C5b-9水平与一组12名年龄匹配的对照患者进行比较。确定了6个月时的综合临床结局（死亡、紧急心脏移植或因心力衰竭恶化住院）。
36例CHF患者的血清C5b-9[中位数（第25至75百分位数）]水平[101.5 ng/mL（40至164）]显著高于12名对照患者[36.5 ng/mL（22至50）]（P = 0.003）。与C5b-9水平较低（最低第50百分位数）的CHF患者相比，C5b-9水平最高（最高第50百分位数）的CHF患者有更多患者出现纽约心脏协会IV级症状（67%对33%；P = 0.04），且6个月时不良临床结局更多（56%对17%；P = 0.02）。
我们描述了有症状心力衰竭患者循环中终末补体复合物C5b-9的显著升高，并观察到高水平的C5b-9与近期不良事件之间的关联。
