Anker S D, Volterrani M, Egerer K R, Felton C V, Kox W J, Poole-Wilson P A, Coats A J
Department of Cardiac Medicine, National Heart and Lung Institute, Imperial College, London, UK.
QJM. 1998 Mar;91(3):199-203. doi: 10.1093/qjmed/91.3.199.
Tumour necrosis factor alpha (TNF alpha) is increased in patients with cardiac cachexia, a condition associated with reduced peripheral blood flow both at rest and after interventions causing vasodilation. By contrast, in patients with chronic heart failure (CHF), higher TNF levels are associated with a greater capacity for vasodilation in the arm. To clarify the relationship between peripheral blood flow and TNF in CHF, we studied the relation between TNF alpha and blood flow in the leg (plethysmography, post maximal exercise and 5 min ischaemia) in 34 patients (age 63 +/- 2 years, ejection fraction 29 +/- 3%, peak VO2 16.6 +/- 1.1 ml/kg/min, mean +/- SEM). Peak leg blood flow correlated significantly with total TNF alpha (r = 0.68, p < 0.0001, peak VO2 (r = 0.54), and soluble TNF receptors 1 (r = 0.56) and 2 (r = 0.52, all p < 0.002). TNF alpha, soluble TNF receptors 1 and 2 and aldosterone correlated with peak blood flow independently of age, ejection fraction, peak VO2 and functional NYHA class. TNF alpha was the only parameter that showed strong correlations for peak blood flow in all clinically relevant subgroups (severe vs. mild, ischaemic vs. dilated, cachectic vs. non-cachectic patients). This study shows a close and inverse relationship between peak leg blood flow and the plasma concentration of TNF alpha, suggesting a pathophysiological role for TNF alpha in reducing peak peripheral blood flow in CHF.
肿瘤坏死因子α（TNFα）在心脏恶病质患者中升高，这种情况与静息时以及引起血管舒张的干预后外周血流减少有关。相比之下，在慢性心力衰竭（CHF）患者中，较高的TNF水平与手臂更大的血管舒张能力相关。为了阐明CHF中外周血流与TNF之间的关系，我们研究了34例患者（年龄63±2岁，射血分数29±3%，峰值VO2 16.6±1.1 ml/kg/min，均值±标准误）腿部血流（体积描记法、最大运动后及5分钟缺血）与TNFα之间的关系。腿部血流峰值与总TNFα显著相关（r = 0.68，p < 0.0001）、与峰值VO2（r = 0.54）、可溶性TNF受体1（r = 0.56）和2（r = 0.52，均p < 0.002）相关。TNFα、可溶性TNF受体1和2以及醛固酮与血流峰值的相关性独立于年龄、射血分数、峰值VO2和纽约心脏协会（NYHA）功能分级。TNFα是唯一在所有临床相关亚组（重度与轻度、缺血性与扩张性、恶病质与非恶病质患者）中均显示与血流峰值有强相关性的参数。本研究表明腿部血流峰值与TNFα血浆浓度之间存在密切的负相关关系，提示TNFα在降低CHF外周血流峰值方面具有病理生理作用。
