Tanner H, Mohacsi P, Fuller-Bicer G A, Rieben R, Meier B, Hess O, Hullin R
Department of Cardiology, University Hospital, Bern, Switzerland.
J Heart Lung Transplant. 2007 Jun;26(6):622-9. doi: 10.1016/j.healun.2007.01.033. Epub 2007 Mar 21.
Activation of the cytokine and the complement system is associated with disease progression in severe congestive heart failure (CHF). Magnitude and prognostic relevance of cytokine and complement activation remain uncertain in patients with moderate CHF.
Measurement of cytokine and complement activation in patients with moderate CHF and testing whether C-reactive protein (CRP) can serve as a surrogate marker of their activation, adding independent prognostic information when co-measured with B-type natriuretic peptide (BNP).
The 118 study participants were separated into three groups based on pre-determined CRP and BNP levels: Group I (n = 27; CRP > 5 mg/liter, BNP > or = 200 pg/ml); Group II (n = 46; CRP < or = 5 mg/liter, BNP > or = 200 pg/ml); and Group III (n = 45; CRP < or = 5 mg/liter, BNP < 200 pg/ml).
Mortality was high in Group I (30%; log-rank p < 0.001) but low in Groups II and III (2% and 4%, respectively; log rank, p = 0.7). No differences were observed for left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) between Groups I and II (31 +/- 16 vs 32 +/- 14% and 66 +/- 16 vs 65 +/- 11 mm, respectively), whereas in Group III LVEF was higher (42 +/- 17%, p = 0.002) with smaller LVEDD (57 +/- 13 mm, p = 0.012). Cytokine sCD14 and tumor necrosis factor (TNF)-alpha levels were not different between the three groups. However, interleukin-6 levels (9.75 +/- 8.17 pg/ml, p = 0.001) and the terminal complement complex C5b-9 (109.9 +/- 68 ng/ml; p = 0.04) were elevated in Group I, both correlating with CRP (interleukin-6: r = 0.5, p < 0.001; C5b-9: r = 0.41, p = 0.001).
CRP may be used as a surrogate parameter for interleukin-6 and complement activation in moderate CHF. CRP in combination with BNP identifies a high-risk group with a tendency for poor outcome not discriminated by cardiac function.
细胞因子和补体系统的激活与严重充血性心力衰竭（CHF）的疾病进展相关。在中度CHF患者中，细胞因子和补体激活的程度及其预后相关性仍不确定。
检测中度CHF患者的细胞因子和补体激活情况，并测试C反应蛋白（CRP）是否可作为其激活的替代标志物，当与B型利钠肽（BNP）联合检测时是否能提供独立的预后信息。
根据预先确定的CRP和BNP水平，将118名研究参与者分为三组：第一组（n = 27；CRP>5mg/升，BNP≥200pg/ml）；第二组（n = 46；CRP≤5mg/升，BNP≥200pg/ml）；第三组（n = 45；CRP≤5mg/升，BNP<200pg/ml）。
第一组的死亡率较高（30%；对数秩检验p<0.001），而第二组和第三组较低（分别为2%和4%；对数秩检验，p = 0.7）。第一组和第二组之间的左心室射血分数（LVEF）和左心室舒张末期直径（LVEDD）无差异（分别为31±16%对32±14%和66±16mm对65±11mm），而第三组的LVEF较高（42±17%，p = 0.002），LVEDD较小（57±13mm，p = 0.012）。三组之间的细胞因子可溶性CD14和肿瘤坏死因子（TNF）-α水平无差异。然而，第一组的白细胞介素-6水平（9.75±8.17pg/ml，p = 0.001）和末端补体复合物C5b-9（109.9±68ng/ml；p = 0.04）升高，两者均与CRP相关（白细胞介素-6：r = 0.5，p<0.001；C5b-9：r = 0.41，p = 0.001）。
在中度CHF中，CRP可作为白细胞介素-6和补体激活的替代参数。CRP与BNP联合可识别出一个预后较差且未被心功能区分的高危组。
