标题：静息心率与慢性心力衰竭患者炎症因子及血脑钠肽的关系

      作者：陆铭，蒋庆渊，刘春兰，刘莹莹，凌佳，阚丽虹，庄晓华，蔡振荣    (上海市浦东医院心血管内科，复旦大学附属浦东医院心血管内科，上海 201399)

      卷次： 2018年29卷1期

      【摘要】 目的 探讨慢性心力衰竭(CHF)患者入院时静息心率与炎症因子及血脑钠肽(BNP)的关系。方法 选择2015年1月至2016年6月在上海市浦东医院心血管内科住院的180例纽约心脏学会(NYHA)心功能分级Ⅱ~Ⅳ级的CHF患者，按静息心率将患者分为A组(心率≤70次/min) 56例，B组(心率: 70~90次/min) 76例，C组(心率>90次/min)48例；患者入院时检测炎症因子C-反应蛋白(CRP)、白介素-1β (IL-1β)、白介素-6 (IL-6)、肿瘤坏死因子α (TNF-α)，血浆BNP水平以及左室射血分数(LVEF)，比较各组患者相关指标的差异。结果 三组患者在炎症因子、血清BNP水平及LVEF方面比较差异均有显著统计学意义(P<0.01)；C组患者与A组和B组的CRP[ (8.52±0.49) mg/L vs (5.87±0.46) mg/Lvs (6.94±0.57) mg/L]、IL-1β [(29.2±3.3) pg/mL vs (16.6±2.7) pg/mL vs (22.7±2.9) pg/mL]、IL-6 [(109.6±11.8) ng/L vs(80.2±9.8) ng/L vs (97.8±12.4) ng/L]、TNF-α [(65.8±12.9) ng/mL vs (33.6±6.8) ng/mL vs (45.8±8.1) ng/mL]及 BNP[(962±106.4) pg/mL vs (595±68.9) pg/mL vs (726±98.3) pg/mL]水平比较，C组明显高于A组和B组，而LVEF [(38.1±6.8)% vs (49.2±5.9)% vs (43.6±5.6)%比较，C组明显低于A组和B组，差异均有统计学意义(P<0.05)；与A组比较，B组患者的 CRP、IL-1β 、IL-6 、TNF-α 及 BNP水平明显增高，LVEF 明显偏低，差异均有统计学意义(P<0.05)；Pearson相关分析显示，所有CHF患者的静息心率与CRP、IL-1β、IL-6、TNF-α及BNP呈正相关(r分别为 0.305、0.297、0.319、0.331和 0.562，P<0.05)，与LVEF呈负相关(r=-0.345，P<0.05)。结论 静息心率水平与慢性心力衰竭患者炎症因子及BNP水平呈正相关，与LVEF呈负相关。
      【关键词】 静息心率；炎症因子；慢性心力衰竭；脑钠肽；相关性
      【中图分类号】 R541.6 【文献标识码】 A 【文章编号】 1003—6350（2018）01—0029—04

Association of resting heart rate with inflammatory factors and brain natriuretic peptide concentration inpatients with chronic heart failure.
LU Ming, JIANG Qing-yuan, LIU Chun-lan, LIU Ying-ying, LING Jia, KANLi-hong, ZHUANG Xiao-hua, CAI Zhen-rong. Department of Cardiology, Shanghai Pudong Hospital, Fudan UniversityPudong Medical Center, Shanghai 201399, CHINA
【Abstract】 Objective To evaluate the relationships of resting heart rate with inflammatory factors and brain na-triuretic peptide (BNP) concentration in patients with chronic heart failure (CHF). Methods From January 2015 toJune 2016, A total of 180 CHF patients in New York Heart Association (NYHA) functional classⅡ-Ⅳ, who admitted toDepartment of Cardiology of Shanghai Pudong Hospital, were enrolled and divided into the group A (≤70 beats/min, n=56), group B (70-90 beats/min, n=76) and group C (>90 beats/min, n=48) according to resting heart rates. The concentra-tion of C-reaction protein (CRP), interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), BNP,left ventricular ejection fracetion (LVEF) at admission were measured and compared. Results There were significant differ-ences between the three groups in inflammatory factors, serum BNP level and LVEF. The levels of CRP, IL-1 β, IL-6,TNF-α, and BNP in the group C were (8.52±0.49) mg/L, (29.2±3.3) pg/mL, (109.6±11.8) ng/L, (65.8±12.9) ng/mL, (962±106.4) pg/mL, respectively, which were significantly higher than (5.87±0.46) mg/L, (16.6±2.7) pg/mL, (80.2±9.8) ng/L,(33.6±6.8) ng/mL, (595±68.9) pg/mL in the group A and (6.94±0.57) mg/L, (22.7±2.9) pg/mL, (97.8±12.4) ng/L], (45.8±8.1) ng/mL, (726±98.3) pg/mL in the group B (P<0.01). While, the LVEF in the group C was (38.1±6.8)%, which wassignificantly lower than (49.2±5.9)% in the group A and (43.6±5.6)% in the group B (P<0.01). Compared with the groupA, the levels of CRP, IL-1β, IL-6, TNF-α and BNP were significantly increased, but LVEF was significantly decreased(P<0.05). Pearson's correlation analysis revealed that resting heart rate had positive correlation with CRP (r=0.305, P<0.05), IL-1β (r=0.297, P<0.05), IL-6 (r=0.319, P<0.05), TNF-α (r=0.331, P<0.05) and BNP levels (r=0.562, P<0.05),and negative correlation with LVEF (r=-0.345, P<0.05). Conclusion In the patients with CHF, resting heart rate is posi-tively correlated with inflammatory factors and BNP levels, and negatively correlated with LVEF.
      【Key words】 Resting heart rate; Inflammatory factors; Chronic heart failure; Brain natriuretic peptide; Corre-lation·论 著·doi:10.3969/j.issn.1003-6350.2018.01.009基金项目：上海市浦东医院科学技术研究项目(编号：201311)