慢性心力衰竭患者血清胆汁酸水平及与炎症细胞因子、心室重构的相关性

Serum bile acid level and its correlation with inflammatory cytokines and ventricular remodeling in patients with chronic heart failure

摘要:

目的 观察武汉地区慢性心力衰竭患者血清胆汁酸水平及与炎症细胞因子、心室重构的相关性。方法 选取2018年1月—2020年1月武汉市第一医院收治的96例慢性心力衰竭患者，根据美国纽约心脏病学会心功能（NYHA）分级标准分为NYHA Ⅱ级组（35例）、NYHA Ⅲ级组（32例）、NYHA Ⅳ级组（29例），另取同期该院健康体检者36例为对照组。统计各组年龄、性别、血压、血糖、血脂、体质量指数（BMI）等一般资料，比较各组血清胆汁酸水平、炎症细胞因子［白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、超敏C反应蛋白（hs-CRP）］及心室重构参数［左心室后壁厚度（LVPWT）、左心室后壁舒张末期厚度（LVPWd）、左心室后壁收缩末期厚度（LVPWs）、室间隔收缩末期厚度（IVSS）、左心室质量指数（LVMI）］，分析慢性心力衰竭患者血清胆汁酸水平与炎症细胞因子、心室重构的相关性。结果 4组年龄、性别、BMI、合并其他疾病、血压、血脂、血糖、HbA1c比较，差异无统计学意义（P >0.05）。NYHA Ⅱ、Ⅲ、Ⅳ级组血清胆汁酸、炎症细胞因子（IL-6、TNF-α、hs-CRP）、心室重构（LVPWT、LVPWd、LVPWs、IVSS、LVMI）高于对照组（P <0.05），且NYHA Ⅳ级组均高于其他组（P <0.05）。Pearson相关性分析结果显示，血清胆汁酸水平与炎症细胞因子（IL-6、TNF-α、hs-CRP）呈正相关（r =0.421、0.284和0.398，P =0.000、0.022和0.000）；与心室重构参数（LVPWT、LVPWd、LVPWs、IVSS、LVMI）呈正相关（r =0.238、0.325、0.289、0.341和0.391，P =0.020、0.012、0.022、0.010和0.001）。结论 血清胆汁酸水平与慢性心力衰竭患者病情密切相关，胆汁酸水平越高，慢性心力衰竭患者炎症反应越重，临床观察其水平变化有助于识别患者病情严重程度及心室重构情况。

Abstract:

Objective To observe the serum bile acid level and its correlation with inflammatory cytokines and ventricular remodeling in patients with chronic heart failure in Wuhan area.Methods A total of 96 patients with chronic heart failure admitted to our hospital from January 2018 to January 2020 were selected. According to New York Heart Association (NYHA) classification, they were divided into NYHA Ⅱ group (n = 35), NYHA Ⅲ group (n = 32), and NYHA Ⅳ group (n = 29). Another 36 cases of healthy individuals undergoing physical examination in our hospital during the same period were selected as the control group. The age, gender, blood pressure, blood sugar, blood lipids, body mass index (BMI) and other general data of each group were analyzed, and the serum levels of bile acid and inflammatory cytokines [interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), and hypersensitivity-C reactive protein (hs-CRP) ], as well as ventricular remodeling parameters [left ventricular posterior wall thickness (LVPWT), left ventricular posterior wall end-diastolic thickness (LVPWd), left ventricular posterior wall end-systolic thickness (LVPWs), interventricular septal end-systolic thickness (IVSS), and left ventricular myocardial mass index (LVMI) ], were compared among the groups. The correlations between serum bile acid levels and inflammatory cytokines and ventricular remodeling parameters in patients with chronic heart failure were analyzed.Results There was no difference in age, gender, body mass index (BMI), comorbidities, blood pressure, blood lipids, blood sugar, and HbA1c among the groups (P > 0.05). The serum levels of bile acid and inflammatory cytokines (IL-6, TNF-α, and hs-CRP), and ventricular remodeling parameters (LVPWT, LVPWd, LVPWs, IVSS, and LVMI) in NYHA Ⅱ, NYHA Ⅲ, and NYHA Ⅳ group were higher than those in the control group (P < 0.05), and they were even higher in the NYHA Ⅳ group compared with the NYHA Ⅱ and NYHA Ⅲ group (P < 0.05). The Pearson correlation analysis demonstrated that the serum bile acid level was positively correlated with the levels of the inflammatory cytokines (IL-6, hs-CRP, and TNF-α) (r = 0.421, 0.398 and 0.284, P = 0.000, 0.000 and 0.022), and with the ventricular remodeling parameters (LVPWT, LVPWd, LVPWs, IVSS, and LVMI) (r = 0.238, 0.325, 0.289, 0.341 and 0.391, P = 0.020, 0.012, 0.022, 0.010 and 0.001).Conclusions The level of serum bile acid is closely related to the disease condition of patients with chronic heart failure. The higher the level of serum bile acid, the severer the inflammatory responses in patients with chronic heart failure. Thus, monitoring the serum bile acid level is helpful to identify the disease severity and the condition of ventricular remodeling in patient with chronic heart failure.