心衰与免疫因子.docVIP

PAGE PAGE 1 慢性充血性心力衰竭与免疫调节异常的研究 摘要 目的：近年来，慢性充血性心力衰竭（CHF）的病理生理研究不断深入，越来越多的证据表明免疫调节异常是CHF的病理生理和发病机制中的重要因子。免疫异常主要表现在：细胞因子异常、淋巴细胞计数及亚群改变、自身抗体的存在、免疫球蛋白及补体的异常改变等。本研究旨在观察CHF患者血清粒细胞-巨噬细胞集落刺激因子（GM-CSF）、抗心磷脂抗体（ACA-IgG）、免疫球蛋白及补体、淋巴细胞计数等免疫学指标水平的变化，并探讨它们与心衰发生发展的关系。方法：采用心脏超声诊断仪测定83 例CHF及20 例健康体检者左室舒张末期内径（LVDd）、左室收缩末期内径（LVDs）、左室射血分数（EF）、心脏指数（CI）等心功能参数；放免法检测血清GM-CSF、酶联免疫法（ELISA）检测ACA-IgG等指标；散色比浊法检测免疫球蛋白及补体、常规检测淋巴细胞计数。结果：1.CHF患者各组年龄、病因、性别、病例数之间均无显著性差异（P0.05），相同病因不同心功能级别（NYHA）之间LVDd、LVDs随心功能级别增加显著升高（P0.05），EF、CI随心功能级别增加显著降低（P0.05）。2.CHF患者血清GM-CSF、ACA-IgG阳性率、免疫球蛋白IgG及补体C3水平显著高于正常对照组，而外周血淋巴细胞计数显著低于正常对照组（P0.05）；血清GM-CSF增加水平与心功能恶化程度呈正相关。3. CHF患者血清GM-CSF、IgG及C3水平与病因无明显相关。结论：1.CHF患者中GM-CSF、IgG及C3水平增高，周围静脉血淋巴细胞计数显著降低，与左室功能障碍程度密切相关，表明CHF患者存在免疫调节异常，提示免疫障碍在促进心衰的发生发展中起着十分重要的作用。2.抗心磷脂抗体是一种自身抗体，可出现在多种自身免疫性疾病和心血管疾病中，CHF患者血清ACA-IgG阳性率显著升高，提示自身抗体可能参与心衰的病理生理过程。 关键词：充血性心力衰竭 粒细胞-巨噬细胞集落刺激因子 抗心磷脂抗体 免疫球蛋白及补体C3 淋巴细胞 An Investigation of Immunoregulatory Abnormality in Patients with Congestive Heart Failure Abstract ： Objective：Recently, the study of pathogenic mechanism in patients with congestive heart failure(CHF) has advanced. A large body of evidence suggests that immunoregulatory abnormality , including cytokine abnormality , lymphocyte count and subsets changing, autoantibodies existing , immunoglobulin and complement C3 abnormality, may be involved in the pathogenic mechanism of CHF. This study was designed to observe the change of the serum Granulocyte - Macrophage Colony Stimulating Factor(GM-CSF) level , anticardiolipin antibodies (ACA) ,immunoglobulin (Ig)and complement C3 levels ,and peripheral blood lymphocyte count(LC) in patients with CHF, and explore the relationship between them and the pathogenesis of CHF. Methods： Left ventricular ejection fractions (EF) , cardiac index (CI) ,left ventricular systole distant (LVDs) and left ventricular diastole distant (LVDd) were measured by echocardiography, the serum ACA andGM-CSF levels were tested with enzyme-linked immunosorbent assay