标题：左心室射血分数正常的慢性心力衰竭患者血清脂联素、肿瘤坏死因子-α的变化及临床意义

      作者：张赞伟，魏文杨，胡小菁    西安市第九医院心血管内科，陕西 西安 710054

      卷次： 2019年30卷19期

      【摘要】 目的 探讨左心室射血分数(LVEF)正常的慢性心力衰竭(CHF)患者血清脂联素、肿瘤坏死因子-α(TNF-α)的变化及临床意义，以期为临床上CHF患者病情程度、判断预后提供参考。方法 选取西安市第九医院心内科 2018年 1月至 2019年 2月间收治的 82例左心室射血分数正常的CHF患者作为研究对象，根据心功能NYHA分级进行分组，其中Ⅱ级 30例，Ⅲ级 28例，Ⅳ级 24例。比较三组受检者血清N末端 B型钠尿肽前体(NT-proBNP)、TNF-α及脂联素水平，以及心超指标 LVEF、左室舒张末期内径(LVEDd)，分析 TNF-α及脂联素与NT-proBNP、LVEF、LVEDd的相关性。结果 随着 NYHA心功能分级水平的增高，血清NT-pro BNP、TNF-α及脂联素水平逐渐增高，LVEDd逐级增加，而LVEF逐渐降低，差异均有统计学意义(P<0.05)；血清TNF-α、脂联素水平与NT-proBNP均呈正相关性(r=0.542、0.492，P<0.05)；血清TNF-α、脂联素与LVEDd呈正相关(r=-0.602、0.523，P<0.05)，与LVEF呈负相关(r=-0.735、-0.647，P<0.05)。结论 血清脂联素、TNF-α水平与LVEF正常的CHF患者的病情严重程度密切相关；检测其水平对评估患者的病情程度、判断预后有一定的临床参考价值。
      【关键词】 慢性心力衰竭；左心室；射血分数；脂联素；肿瘤坏死因子-α
      【中图分类号】 R541.6 【文献标识码】 A 【文章编号】 1003—6350（2018）19—2459—03

Changes and clinical significance of serum adiponectin and TNF-α in patients with chronic heart failure andpreserved left-ventricular ejection fraction.
ZHANG Zan-wei, WEI Wen-yang, HU Xiao-jing. Department ofCardiovascular Medicine, the Ninth Hospital of Xi'an City, Xi'an 710054, Shaanxi, CHINA
【Abstract】 Objective To investigate the changes and clinical significance of serum adiponectin and tumornecrosis factor-alpha (TNF-alpha) in patients with chronic heart failure (CHF) and normal left ventricular ejection frac-tion (LVEF), in order to provide some help for clinical CHF patients to judge the degree of disease and prognosis.Methods A total of 82 CHF patients with chronic heart failure and preserved left-ventricular ejection fraction, whotreated in the Ninth Hospital of Xi'an from January 2018 to February 2019, were selected as the study subjects. The pa-tients were grouped according to NYHA classification of cardiac function, including 30 cases of grade Ⅱ, 28 cases ofgrade Ⅲ and 24 cases of grade Ⅳ. The serum levels of NT-proBNP, TNF-α and adiponectin, left ventricular ejectionfraction (LVEF), left ventricular end-diastolic diameter (LVEDd) were compared among the three groups. The correla-tion between TNF-α and adiponectin and NT-proBNP, LVEF and LVEDd was analyzed. Results The serum levels ofNT-pro BNP, TNF-α and adiponectin increased, LVEDd increased, and LVEF decreased with the increase of NYHA car-diac function grade (P<0.05); the serum levels of TNF-α and adiponectin were positively correlated with NT-proBNP (r=0.542, 0.492, P<0.05); the serum levels of TNF-α and adiponectin were positively correlated with LVEDd (r=-0.602,0.523, P<0.05). It was negatively correlated with LVEF (r=-0.735, -0.647, P<0.05). Conclusion The levels of serumadiponectin and TNF-alpha are closely related to the severity of CHF patients with normal LVEF. Detecting the levels ofadiponectin and TNF-alpha has certain clinical reference value for evaluating the severity of CHF patient's condition andjudging the prognosis.
      【Key words】 Chronic heart failure(CHF); Left ventricle; Ejection fraction; Adiponectin; Tumor necrosis factor-α(TNF-α)