尿毒症患者合并心力衰竭血清TNF-α、NO与ET水平的变化及临床意义(1)
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[摘要] 目的:探讨尿毒症患者合并心力衰竭(心衰)时血液透析前后血清肿瘤坏死因子-α(TNF-α)、一氧化氮(NO)和内皮素(ET)水平的变化及临床意义。方法:58例尿毒症合并心衰患者透析前后分别抽取静脉血,用ELISA法检测患者血清TNF-α水平,NO与ET水平分别用硝酸还原酶法和放射免疫法测定。同时用超声心动图检测患者心功能。设56例正常查体者为对照组,进行对比研究。结果:尿毒症患者合并心衰时多伴有心脏多瓣膜反流,左室射血分数(LVEF)减小,患者TNF-α和ET水平较对照组明显升高,而血清NO水平较对照组明显降低。患者血清TNF-α与ET水平呈正相关,血清TNF-α与NO、ET与NO均呈负相关。透析后在干体重状态时TNF-α、ET浓度下降,心脏功能有所改善。结论:透析前TNF-α、ET浓度与LVEF值呈负相关,TNF-α、ET浓度的升高可使心室收缩不良并舒张受限。TNF-α、ET是尿毒症患者心衰发生和发展的重要危险因素之一,检测患者TNF-α、NO与ET水平可作为判断预后、指导治疗的指标。
[关键词] 尿毒症;心力衰竭;肿瘤坏死因子;一氧化氮;内皮素
[中图分类号] R692.5[文献标识码]A [文章编号]1673-7210(2009)08(a)-025-02
The change and clinical significance of TNF-α, NO and ET level in patients with uremia complicated with heart failure
HOU Huizhen, SI Tinglin
(The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250001, China)
[Abstract] Objective: To investigate the change and clinical significance of tumor necrosis factor alpha (TNF-α), nitric oxide (NO) and endothelin (ET) level in patients with uremia complicated with heart failure before and after hematodialysis. Methods: 58 cases of patients with uremia complicated with heart failure were drawn venous blood before and after hematodialysis, the level of serum TNF-α was detected by ELISA, and the level of NO and ET was detected by nitrate reductase enzymatic method and radioimmunoassay respectively. Meanwhile, the heart functions of patients were determined by echocardiography. 56 cases of normal people were served as control group, a comparative study was developed. Results: The majority of patients with uremia complicated with heart failure had several heart valve regurgitation, left ventricular ejection fraction (LVEF) was decreased, and TNF-α and ET level was obviously higher than that of the control group, and the level of NO was significantly lower than that of the control group ......
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