【摘要】 目的 探讨充血性心力衰竭(Congestive Heart lailure CHF)患者外周血辅助性T淋巴细胞功能失调及其在心力衰竭发生及发展中的意义。方法 选择62例充血性心力衰竭患者作为实验组，并按照纽约心脏病协会(NYHA)分为心功能Ⅱ级(28例)，心功能Ⅲ级(16例)，心功能Ⅳ级(18例)，另选30例健康志愿者作为对照组。采用流式细胞分析法，检测所有被检者外周血CD4+细胞胞内细胞因子干扰素γ(IFN-γ)和白细胞介素4(IL-4)的表达。同时分离外周血单核细胞(PBMC)，经植物血凝素(PHA)刺激培养后，应用酶联免疫吸附方法(ELISA)检测培养上清液中IFN-γ和IL-4水平。结果 充血性心力衰竭组患者IFN-γ染色阳性的细胞占CD4+T细胞的比率为17.48%，明显高于对照组的12.09% 。IL-4染色阳性细胞比率在两组间未见显著统计学差异。ELISA检测显示心力衰竭组培养上清液中IFN-γ水平及IFN-γ/IL-4比值明显高于对照组，而两组间IL-4水平则无显著统计学意义。结论 心力衰竭患者辅助性T淋巴细胞功能与心功能之间有一定关系，且与心功能级别呈正相关。辅助性T淋巴细胞功能失调可能参与了CHF患者的心室重构过程。

    【关键词】 心力衰竭；T淋巴细胞；细胞因子；干扰素γ；白细胞介素4

    The investigation of cell-mediated immunity function imbalance in patients with congestive heart failure

    CHEN bing-xue,WANG Ling-ling,LIU li,et al.Department of Internal Medicine, Bethune Military Medical College, Shijiazhuang 050081, China

    【Abstract】 Objective To explore the significance of cell-mediated immunity function imbalance in patients with congestive heart failure.Methods Six-two patients with congestive heart failure were included and divided into 3 groups according to the New York Heart Association (NYHA),thirty healthy men were studied as control. The heart function was evaluated by two-dimensional echocardiography. Peripheral blood mononuclear cells(PBMCs) were collected from these patients.Cytokine-producing CD4+ T cells were quantified by 3-color flow cytometry after bring stimulated with phorbol myristate acetate (PMA) and ionomyccin. After being stimulated with PHA, the levels of IFN-γ and IL-4 in culture supernatants were measured by ELISA.Results The frequencies of IFN-γ-producing T cells were found to be significantly higher in congestive heart failure group(17.48%) than that in control group(12.09%). There was no significant difference on the frequencies of IL-4-producing peripheral T-lymphocytes between the two groups. The IFN-γ level and the ratios of IFN-γ/IL-4 in congestive heart failure group were significantly higher than that of control. While there was no significant difference in IL-4 level between the two groups.Conclusion The cell-mediated immunity function was associated with heart function in patients with congestive heart failure. The up-regulation of T cell function was consistent with poor heart function, suggesting that cell-mediated immunity function imbalance may participate in ventricular remodeling after heart failure. ......