中国血液净化

›› 2004, Vol. 3 ›› Issue (4): 201-204.

• 论著 • 上一篇    下一篇

尿毒症患者血清白细胞介素-6与肿瘤坏死因子-α的变化与左心功能的相关分析及血液透析对其影响的研究

王秀玲 孙晓红   

  1. 830054 乌鲁木齐，新疆医科大学第一附属医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2004-04-12 发布日期:2004-04-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2004-04-12 Published:2004-04-12

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摘要： 目的 探讨尿毒症患者血清白细胞介素-6 （Interleukin-6, IL-6）和肿瘤坏死因子-α（Tumor necrosis factor-alpha, TNF-α）水平的变化及其与左心功能之间的关系，并观察血液透析前后IL-6、TNF-α的变化。方法 检测22例健康人、22例尿毒症未透析患者以及22例维持性血液透析患者血液透析前、后血清IL-6、TNF-α的水平，采用心脏超声测定22例健康人和22例尿毒症未透析患者的左室射血分数（LVEF）、二尖瓣舒张早期最大血流速度（E）和二尖瓣血流心房收缩期最大流速（A）以及两者的比值（E/A）。结果 ①22例尿毒症未透析患者以及透析患者血液透析前、透析后血清IL-6、TNF-α水平均高于对照组，差异有显著性 （P<0.05）。维持性血液透析患者透析前、透析后血清 IL-6、TNF-α水平相比无显著性差异（P>0.05）；②与对照组相比，22例尿毒症未透析患者中有11例(50.0%)左室舒张功能减退，有8例（36.7%） 左室收缩功能不全， 有4例 (18.2%) 同时合并有舒张功能和收缩功能不全（P < 0.05）;③尿毒症患者未透析组血清 IL-6、TNF-α水平与E/A值、EF%呈负相关 （P<0.05）， IL-6与TNF-α呈正相关（P<0.01）。结论 IL-6与 TNF-α可能参与了尿毒症及其心血管并发症的发生、发展，两者协同作用可加速心功能的恶化。细胞因子的产生和释放主要是由尿毒症本身免疫细胞处于激活状态所致而不是由透析膜影响体内的炎症反应所致。

关键词: 尿毒症, 血液透析, 白细胞介素-6, 肿瘤坏死因子-α, 左心功能

Abstract:

Objective To investigate the relationship between the changes of serum interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) and left cardiac function in uremic patients and the effect of hemodialysis (HD) on these cytokines. Methods The levels of serum IL-6 and TNF-α were measured in 22 normal controls, 22 non-HD, and 22 maintenance HD uremic patients, before and after dialysis. The left ventricular ejective fraction (LVEF), early mitral inflow peak velocity (E), atrial mitral inflow peak index (A), and ratio of E to A (E/A) were assessed by echocardiogram in 22 non-HD uremic patients and in 22 normal controls. Result The levels of serum IL-6 and TNF-α in 22 non-HD and 22 HD uremic patients before and after hemodialysis were elevated compared to normal controls, there were significant differences (P<0.05). There were no significant differences in maintenance HD uremic patients before and after dialysis ( P>0.05). Compared with control group, 11 cases (50.0%) had cardiac diastolic dysfunction while 8 cases (36.7%) had cardiac systolic dysfunction, and 4 cases (18.2%) had cardiac diastolic and systolic dysfunction at the same time in 22 non-HD uremic patients (P<0.05). In non-HD uremic patients, IL-6 and TNF-α correlated negatively with LVEF and E/A (P<0.05), IL-6 correlated positively with TNF-α (P<0.01). Conclusion IL-6 and TNF-α probably involve in the presence and the progression of uremia and its cardiovascular complications, the synergism of them could deteriorate cardiac function. Immune cells in uremia patients which are in an activated state are responsible for the porduction and release of cytokines rather than the in-flammatory response affected by dialysis membranes.

Key words: Hemodialysis, Interleukin-6, Tumor necrosis factor-alpha, Left cardiac function

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