Nishimura Masato, Hashimoto Tetsuya, Kobayashi Hiroyuki, Fukukda Toyofumi, Okino Koji, Yamamoto Noriyuki, Nakamura Naoto, Yoshikawa Toshikazu, Takahashi Hakuo, Ono Toshihiko
Cardiovascular Division, Toujinkai Hospital, Kyoto, Japan.
J Nephrol. 2003 Sep-Oct;16(5):641-9.
Tumor necrosis factor (TNF)-alpha causes hypertrophic as well as negative inotropic effects on cardiac myocytes. Circulating TNF-alpha levels are reported to be elevated in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis (HD). We investigated whether increased circulating TNF-alpha is associated with left ventricular remodeling against pressure and/or volume overload in HD patients with or without diabetes mellitus.
Echocardiography and the measurement of plasma TNF-alpha and B-type natriuretic peptide (BNP) concentrations, one of the parameters indicating left ventricular wall stress, were performed on 176 ESRD patients undergoing maintenance HD (88 non-diabetic and 88 diabetic patients).
The mean plasma TNF-alpha concentrations were high, but did not differ between non-diabetic and diabetic patients (9.8 +/- 4.3 pg/mL vs. 9.9 +/- 5.4 pg/mL). In non-diabetic patients, plasma TNF-alpha concentration correlated positively with interventricular septal wall thickness (IVST) and relative left ventricular wall thickness (rLVWT), and inversely with left intraventricular dimensions, but did not correlate with left ventricular mass index (LVMI). In contrast, in diabetic patients, plasma TNF-alpha concentration correlated positively with plasma BNP concentration (r=0.821, p=0.0001) and left intraventricular dimensions, and inversely with rLVWT (r=-0.407, p=0.0001) and left ventricular fractional shortening (r=-0.445, p=0.0001).
Circulating TNF-alpha is possibly involved in concentric left ventricular remodeling in non-diabetic HD patients, whereas it is associated with eccentric left ventricular remodeling against sustained pressure and/or volume overload in diabetic HD patients.
肿瘤坏死因子（TNF）-α对心肌细胞具有肥厚及负性肌力作用。据报道，接受维持性血液透析（HD）的终末期肾病（ESRD）患者循环中TNF-α水平升高。我们研究了循环中TNF-α升高是否与有或无糖尿病的HD患者抵抗压力和/或容量超负荷的左心室重构有关。
对176例接受维持性HD的ESRD患者（88例非糖尿病患者和88例糖尿病患者）进行超声心动图检查，并测量血浆TNF-α和B型利钠肽（BNP）浓度，BNP是指示左心室壁应力的参数之一。
血浆TNF-α平均浓度较高，但非糖尿病患者和糖尿病患者之间无差异（9.8±4.3 pg/mL对9.9±5.4 pg/mL）。在非糖尿病患者中，血浆TNF-α浓度与室间隔厚度（IVST）和相对左心室壁厚度（rLVWT）呈正相关，与左心室内径呈负相关，但与左心室质量指数（LVMI）无相关性。相反，在糖尿病患者中，血浆TNF-α浓度与血浆BNP浓度呈正相关（r = 0.821，p = 0.0001）和左心室内径，与rLVWT（r = -0.407，p = 0.0001）和左心室缩短分数（r = -0.445，p = 0.0001）呈负相关。
循环中的TNF-α可能参与非糖尿病HD患者的向心性左心室重构，而在糖尿病HD患者中，它与抵抗持续压力和/或容量超负荷的离心性左心室重构有关。
