Lommi J, Pulkki K, Koskinen P, Näveri H, Leinonen H, Härkönen M, Kupari M
Division of Cardiology (Department of Medicine), Helsinki University Central Hospital, Finland.
Eur Heart J. 1997 Oct;18(10):1620-5. doi: 10.1093/oxfordjournals.eurheartj.a015142.
Increased activity of pro-inflammatory cytokines in the circulation has been observed in many, though not all, patients with congestive heart failure. To identify the predictors of cytokine activation in congestive heart failure, we assessed the relationship of peripheral and hepatic venous cytokines to central haemodynamics, neuroendocrine status and intermediary metabolism in patients with moderate or severe congestive heart failure.
Concentrations of tumour necrosis factor-alpha, soluble tumour necrosis factor-receptor II and interleukin 6 were measured from peripheral and hepatic venous plasma in 58 adult cardiac patients, of whom 44 had congestive heart failure, undergoing heart catheterization, echocardiography and assessment of selected neuroendocrine and metabolic characteristics.
Peripheral venous soluble tumour necrosis factor-receptor II was directly related to NYHA class (rs = 0.46, P < 0.001) and inversely to 6-min walking distance (rs = -0.46, P < 0.001). Peripheral venous tumour necrosis factor-alpha was related to 6-min walking distance (rs = -0.37, P < 0.01), but like soluble tumour necrosis factor-receptor II, was unrelated to other haemodynamic and neuroendocrine measurements. Peripheral venous interleukin 6 correlated with NYHA class (rs = 0.66, P < 0.001) and 6-min walking distance (rs = -0.52, P < 0.001). In addition, interleukin 6 was related to right atrial pressure (rs = 0.55, P < 0.001), pulmonary artery wedge pressure (rs = 0.50, P < 0.001) and left ventricular ejection fraction (rs = -0.39, P < 0.01); in multivariate analysis, only right atrial pressure was an independent predictor of interleukin 6 concentration (P < 0.001). Comparisons between patients with and without congestive heart failure showed significantly higher hepatic venous tumour necrosis factor-alpha, soluble tumour necrosis factor-receptor II and interleukin 6 in the heart failure group; the differences in peripheral venous cytokines were less consistent.
In cardiac patients, increased plasma tumour necrosis factor-alpha and soluble tumour necrosis factor-receptor II are associated with symptoms of heart failure and poor exercise capacity, while the most important predictor of increased interleukin 6 is elevated systemic venous pressure. Different but still unknown mechanisms may be responsible for the increased release of cytokines in congestive heart failure.
在许多（但并非所有）充血性心力衰竭患者中，已观察到循环中促炎细胞因子活性增加。为了确定充血性心力衰竭中细胞因子激活的预测因素，我们评估了中度或重度充血性心力衰竭患者外周血和肝静脉细胞因子与中心血流动力学、神经内分泌状态及中间代谢之间的关系。
检测了58例成年心脏病患者外周血和肝静脉血浆中肿瘤坏死因子-α、可溶性肿瘤坏死因子受体II和白细胞介素6的浓度，其中44例患有充血性心力衰竭，这些患者均接受了心脏导管检查、超声心动图检查以及选定的神经内分泌和代谢特征评估。
外周静脉可溶性肿瘤坏死因子受体II与纽约心脏协会（NYHA）心功能分级直接相关（rs = 0.46，P < 0.001），与6分钟步行距离呈负相关（rs = -0.46，P < 0.001）。外周静脉肿瘤坏死因子-α与6分钟步行距离相关（rs = -0.37，P < 0.01），但与可溶性肿瘤坏死因子受体II一样，与其他血流动力学和神经内分泌指标无关。外周静脉白细胞介素6与NYHA心功能分级（rs = 0.66，P < 0.001）和6分钟步行距离（rs = -0.52，P < 0.001）相关。此外，白细胞介素6与右心房压力（rs = 0.55，P < 0.001）、肺动脉楔压（rs = 0.50，P < 0.001）和左心室射血分数（rs = -0.39，P < 0.01）相关；在多变量分析中，只有右心房压力是白细胞介素6浓度的独立预测因素（P < 0.001）。有充血性心力衰竭患者与无充血性心力衰竭患者的比较显示，心力衰竭组肝静脉肿瘤坏死因子-α、可溶性肿瘤坏死因子受体II和白细胞介素6显著更高；外周静脉细胞因子的差异不太一致。
在心脏病患者中，血浆肿瘤坏死因子-α和可溶性肿瘤坏死因子受体II增加与心力衰竭症状及运动能力差相关，而白细胞介素6增加的最重要预测因素是全身静脉压升高。充血性心力衰竭中细胞因子释放增加可能由不同但仍未知的机制所致。
