Yamaji Masayuki, Tsutamoto Takayoshi, Kawahara Chiho, Nishiyama Keizo, Yamamoto Takashi, Fujii Masanori, Horie Minoru
Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Japan.
Circ Heart Fail. 2009 Nov;2(6):608-15. doi: 10.1161/CIRCHEARTFAILURE.109.868513. Epub 2009 Sep 28.
The pathophysiological role of cortisol, which binds to the mineralocorticoid receptor with an affinity equal to that of aldosterone (ALD), may be influenced by oxidative stress in patients with chronic heart failure. We evaluated cardiac event prediction using cortisol levels in chronic heart failure, in comparison with ALD, adrenocorticotropic hormone, and brain natriuretic peptide (BNP), and the impact of oxidative stress.
We measured the plasma levels of biomarkers such as BNP, ALD, adrenocorticotropic hormone, serum cortisol, and oxidized low-density lipoprotein (oxLDL), a biomarker of oxidative stress, in 319 consecutive symptomatic patients with chronic heart failure, and we followed these patients for a mean period of 33 months. During the follow-up period, 29 patients had cardiac events (death or hospitalization). Plasma levels of BNP, ALD, adrenocorticotropic hormone, oxLDL, and serum cortisol (16.8+/-1.8 microg/dL versus 12.4+/-0.3 microg/dL, P=0.01) were significantly higher in patients with cardiac events than in those without cardiac events. On stepwise multivariate analyses, high levels of BNP (P=0.0003), renin (P=0.002), cortisol (P=0.02), and oxLDL (P=0.002) were independent predictors of cardiac events, but ALD and adrenocorticotropic hormone levels were not. In patients with serum cortisol > or =12.5 microg/dL, the hazard ratio of cardiac events in patients with oxLDL > or =12 U/mL was 3.5 compared with that in patients with oxLDL <12 U/mL (P=0.008).
These findings indicate that serum cortisol levels were a complementary and incremental cardiac event risk predictor in combination with BNP in patients with chronic heart failure and that cardiac event prediction based on cortisol levels was influenced by oxidative stress.
皮质醇与盐皮质激素受体的结合亲和力与醛固酮（ALD）相当，其病理生理作用可能受慢性心力衰竭患者氧化应激的影响。我们评估了慢性心力衰竭患者使用皮质醇水平预测心脏事件的情况，并与ALD、促肾上腺皮质激素和脑钠肽（BNP）进行比较，同时评估了氧化应激的影响。
我们测量了319例有症状的慢性心力衰竭连续患者的血浆生物标志物水平，如BNP、ALD、促肾上腺皮质激素、血清皮质醇和氧化应激生物标志物氧化型低密度脂蛋白（oxLDL），并对这些患者进行了平均33个月的随访。在随访期间，29例患者发生了心脏事件（死亡或住院）。发生心脏事件的患者血浆BNP、ALD、促肾上腺皮质激素、oxLDL和血清皮质醇水平（16.8±1.8μg/dL对12.4±0.3μg/dL，P=0.01）显著高于未发生心脏事件的患者。在逐步多变量分析中，高水平的BNP（P=0.0003）、肾素（P=0.002）、皮质醇（P=0.02）和oxLDL（P=0.002）是心脏事件的独立预测因素，但ALD和促肾上腺皮质激素水平不是。血清皮质醇≥12.5μg/dL的患者中，oxLDL≥12 U/mL的患者心脏事件风险比oxLDL<12 U/mL的患者高3.5倍（P=0.008）。
这些发现表明，在慢性心力衰竭患者中，血清皮质醇水平与BNP联合是心脏事件风险的补充性和增量性预测指标，且基于皮质醇水平的心脏事件预测受氧化应激影响。
