Haugen Espen, Gan Li-Ming, Isic Azra, Skommevik Tomas, Fu Michael
Department of Molecular and Clinical Medicine, Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy, Gothenburg University.
Exp Clin Cardiol. 2008 Spring;13(1):19-24.
Increased proinflammatory cytokines have mainly been studied in younger patients with heart failure and are regarded as prognostic markers. However, whether this holds true in elderly patients with heart failure remains uncertain.
To determine whether inflammation is equally important in the progression of heart failure in the elderly as has been previously reported in younger patients, and whether cytokine level can predict mortality in this population of elderly heart failure patients.
The cytokine profile in an elderly patient group with severe heart failure (n=54, mean [+/- SD] age of 80.1+/-5.0 years, New York Heart Association class III or IV) was compared with that of age-matched healthy individuals (n=70). Of the 54 study patients, 46% were hypertensive, 54% had coronary artery disease, 43% had atrial fibrillation and 24% had a previous stroke. One-year mortality was 24%.
The results showed increased levels of interleukin-6 (IL-6), tumour necrosis factor-alpha and epidermal growth factor in the heart failure patients compared with those in the control group. Moreover, IL-6, tumour necrosis factor-alpha and vascular endothelial growth factor were significantly increased in patients who died within one year. Further logistic regression analyses showed that IL-6 was the only significant predictor of one-year mortality. In a subgroup of heart failure patients with atrial fibrillation, there were significant cytokine activations, whereas in a subgroup with ischemia or diabetes, cytokines were less activated.
In the present octogenarian group with heart failure, there were significant increases of inflammatory cytokines that were associated with mortality, and IL-6 was the only cytokine to predict one-year mortality. Cytokine activation was more pronounced in the subgroup of patients with heart failure and concomitant atrial fibrillation.
促炎细胞因子增加主要在年轻心力衰竭患者中进行研究，并被视为预后标志物。然而，在老年心力衰竭患者中是否也是如此仍不确定。
确定炎症在老年人心力衰竭进展中是否与先前在年轻患者中报道的一样重要，以及细胞因子水平是否可预测该老年心力衰竭患者群体的死亡率。
将一组重度心力衰竭老年患者（n = 54，平均[±标准差]年龄80.1±5.0岁，纽约心脏协会III或IV级）的细胞因子谱与年龄匹配的健康个体（n = 70）进行比较。54例研究患者中，46%患有高血压，54%患有冠状动脉疾病，43%患有心房颤动，24%曾有中风史。一年死亡率为24%。
结果显示，与对照组相比，心力衰竭患者的白细胞介素-6（IL-6）、肿瘤坏死因子-α和表皮生长因子水平升高。此外，在一年内死亡的患者中，IL-6、肿瘤坏死因子-α和血管内皮生长因子显著升高。进一步的逻辑回归分析表明，IL-6是一年死亡率的唯一显著预测因子。在伴有心房颤动的心力衰竭患者亚组中，有明显的细胞因子激活，而在伴有缺血或糖尿病的亚组中，细胞因子激活较少。
在目前的老年心力衰竭患者组中，炎症细胞因子显著增加且与死亡率相关，IL-6是预测一年死亡率的唯一细胞因子。细胞因子激活在伴有心房颤动的心力衰竭患者亚组中更为明显。
