rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2005-1520rsp-1326Research ArticleСтатьиArticlesИсследование провоспалительных цитокинов и мозгового натриуретического пептида у больных с ревматическими пороками сердца и ишемической болезнью сердца, осложненными хронической сердечной недостаточностьюEvaluation of proinflammatory cytokines and brain natriuretic peptide in patients with rheumatic heart diseases and coronary heart disease complicated by chronic heart insufficiencyShoslakN AShoslakN A-PoskrebyshevaA SPoskrebyshevaA S-KopylovaA AKopylovaA A-200515042005432№2 (2005)2528Copyright © Shoslak N.A., Poskrebysheva A.S., Kopylova A.A., 20052005Shoslak N.A., Poskrebysheva A.S., Kopylova A.A.Shoslak N.A., Poskrebysheva A.S., Kopylova A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/1326

Цель. Исследовать проьоспалительные цитокины и мозговой натрийуретический пептид у больных ревматическими пороками сердца (РПС) и ИБС, осложненными хронической сердечной недостаточностью (ХСН). Материал и методы. Обследовано 16 больных с РПС и 38 с ИБС, все с признаками ХСН II - IVФК по NYHA (UA-III стадией по классификации Н. Д. Стражеско - В. X. Василенко) и 30 клинически здоровых лиц - контрольная группа. Больным применялись клинические и общепринятые лабораторные и инструментальные методы обследования с тщательным анализом Эхо-КГ; проводилось количественное определение сывороточных ФНО-а, ИЛ-6 и мозгового натрийуретического пептида (МНУП) методом иммуноферментного анализа. Результаты. Выявлена прямая зависимость между содержанием цитокинов и МНУП в крови и тяжестью клинического состояния больного с ХСН . Показано достоверное отличие указанных показателей при ХСН ишемической и не ишемической (РПС) природы. Концентрация ФНО-а была минимальной при митральным стенозе. Максимальные концентрации ИЛ-6 и ФНО-а наблюдались при трикуспидальной недостаточности. Концентрация ФНО-а нарастала при увеличении линейных размеров сердца (при увеличении ЛП>50мм в 2,97 раза, при КДР>56мм - в 1,58 раза, при уменьшении ФВ<40 % в 2,3 раза). Подобные, но менее выраженные тенденции, наблюдались в отношении МНУП. Заключение. Установлено достоверное отличие изученных показателей при ХСН ишемической и не ишемической (РПС) природы. Отмечено, что, несмотря на однотипность клинических проявлений ХСН, уровень биологических показателей воспаления был достоверно ниже при РПС, чем при ИБС, что требует дальнейшего обсуждения.

Objective. To study proinflammatory cytokines and brain natriuretic peptide (BNP) in patients with rheumatic heart diseases (RHD) and coronary heart disease (CHD) complicated by chronic heart insufficiency (CHI). Material and methods. 54 pts with CHI (among them 16 with RHD and 38 with CHD with signs of CHI ofll-IV functional class according to NYHA that correspond to 11A-III stage according to N.D. Strazesko-V.H. \frsilenko classification) and 30 healthy persons of control group were examined. Besides clinical evaluation common laboratory and instrumental methods were used. Thorough echocardiography analysis, quantitative evaluation of serum TNF a, IL6 and BNP by immuno-enzyme assay was performed. Results. Direct correlation between cytokines and BNP levels and pts with CHI clinical state severity was revealed. These indiccs significantly differed in coronary and non-coronary (RHD) CHI. TNF a concentration was minimal in mitral stenosis. Maximal concentrations of IL6 and TNF a were revealed in tricuspid regurgitation. TNF a concentration elevated with increase of heart linear dimensions. BNP showed similar but less prominent tendencies. Conclusion. Significant difference of studied indices in coronary and non-coronary (RHD) CHI was shown. Despite of similarity of CHI clinical features levels of inflammation biological indices in RHD was significantly lower than in CHD that requires further discussion.

ревматические пороки сердцахроническая сердечная недостаточностьцитокиныфактор некроза опухолиинтерлейкин-6мозговой натрийуретический пептидrheumatic heart diseaseschronic heart insufficiencytumor necrosis factor ainterleukin 6brain natriuretic peptideReferences<div><p>Bozkurt В., Kribbs S.B., Clubb FJ. et al. Pathophysiologically relevant concentrations of tumor necrosis factor-alfa promote progressive left ventricular dysfunction and remodeling in rats. II. Circulation, 1998,97, 1382-1391</p><p>Dutka D.P., Elbern J.S., Delamere F. Tumor necrosis factor alpha in severe congestive heart failure. Br. Heat. J., 1993, 70, 12. 141-143</p><p>Katz S.D., Rao R., Berman J.W. et al. Pathophysiologicaly correlates of increased serum tumor necrosis factor in patients with 13. congestive heart failure: relation to nitryc oxide-dependent vasodilatation in the forearm circulation. Circulation, 1994, 90, 14. 12-16</p><p>Levine B., Kalman J., Mayer L. et al. Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N. Engl. 15. J. Med., 1990, 323, 236-241</p><p>Mann. D.J., Young J.B. Basic mechanisms in congestive heart failure. Recognizing the role of proinflammatory cytokines. Chest, 1994, 105, 897-904 16.</p><p>Matsumori A., Yamada Т., Suzuki H. et al. Increased circulating cytokines in patients with myocarditis and cardiomyopathy. Br. Heart J., 1994,72,561-566 O.Yegin, M.Coskun, H.Ertug. Cytokines in acute rheumatic fever. J. Autoimmun., 2001, 16(3), 363-367</p><p>Kutukculer N., Narin N. Plasma interleukin-7 (IL-7) and IL-8 concentrations in acute rheumatic fever and chronic rheumatic heart disease. Clin. Exp. Immunol., 1993, 91(3), 429-436</p><p>Narin N. Kutukculer N., Ozyurek R., Bakilcr A.R. 18. Lymphocyte subsets and plasma IL-t alpha, IL-2, and TNF- alpha concentrations in acute rheumatic fever and chronic rheumatic heart disease. Scand. J. Rheumatol., 1995, 24(6), 383-385</p><p>Morris K., Mohan C., W&amp;hi P.L., et al. Enhancement of IL-1, IL-2 production and IL-2 receptor generation in patients with acute rheumatic fever and active rheumatic heart disease: a prospective study. Arch. Dis. Child., 1992,67(11), 1373-1375</p><p>Zedan M.M., el-Shennawy F.A., Abou-Bakr H.M.,.al-Basousy A.M. Interleukin-2 in relation to T cell subpopulations in rheumatic heart disease. J. Rheumatol. ,1989, 16(11), 1436-1442</p><p>Насонов Е.Л., Самсонов М.Ю., Беленков Ю.Н., Фукс Д. Иммунопатология застойной сердечной недостаточности: роль цитокинов. Кардиол., 1999, 39,3, 66-73</p><p>Reid М.В., Li Y.P. Cytokines and oxidative signaling in skeletal muscle. Acta Physiol. Scand., 2001,171, 225-232 Kiemer A.K., follmar A.M. The atrial natriuretic peptide regulates the production of inflammatory mediators in macrophages. Ann. Rheum. Dis., 2001, 60, 68-70.</p><p>Deswal A., Petersen N.J., Feldman A.M. et al. Cytokines and cytokine receptors in advanced heart failure: an analysis of the cytokine database from the Vesnarinone Trial (VEST). Circulation, 2001, 103, 2055-2059</p><p>Parissis J.T., Adamopoulos S., fenetsanou K.F. et al. Clinical and neurohormonal correlates of circulating granulocyte- macrophage A9-10 colony-stimulating factor in severe heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am. J. Cardiol., 2000, 86, 707-710.</p><p>Oral H., Sivasubramanian N. Dyke D.B. et al. Myocardial proinflammatory cytokine expression and left ventricular remodeling in patients with chronic mitral regurgitation. Eur. J. Heart Fail., 2000, 2(4), 387-91</p><p>Ikeda U., Yamamoto K., Akazawa H. et al. Plasma cytokine levels in cardiac chambers of patients with mitral stenosis with congestive heart failure. Cardiol., 1996,87 (6),476-480</p></div><br /><div><p>Bozkurt В., Kribbs S.B., Clubb FJ. et al. Pathophysiologically relevant concentrations of tumor necrosis factor-alfa promote progressive left ventricular dysfunction and remodeling in rats. II. Circulation, 1998,97, 1382-1391</p><p>Dutka D.P., Elbern J.S., Delamere F. Tumor necrosis factor alpha in severe congestive heart failure. Br. Heat. J., 1993, 70, 12. 141-143</p><p>Katz S.D., Rao R., Berman J.W. et al. Pathophysiologicaly correlates of increased serum tumor necrosis factor in patients with 13. congestive heart failure: relation to nitryc oxide-dependent vasodilatation in the forearm circulation. Circulation, 1994, 90, 14. 12-16</p><p>Levine B., Kalman J., Mayer L. et al. Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N. Engl. 15. J. Med., 1990, 323, 236-241</p><p>Mann. D.J., Young J.B. Basic mechanisms in congestive heart failure. Recognizing the role of proinflammatory cytokines. Chest, 1994, 105, 897-904 16.</p><p>Matsumori A., Yamada Т., Suzuki H. et al. Increased circulating cytokines in patients with myocarditis and cardiomyopathy. Br. Heart J., 1994,72,561-566 O.Yegin, M.Coskun, H.Ertug. Cytokines in acute rheumatic fever. J. Autoimmun., 2001, 16(3), 363-367</p><p>Kutukculer N., Narin N. Plasma interleukin-7 (IL-7) and IL-8 concentrations in acute rheumatic fever and chronic rheumatic heart disease. Clin. Exp. Immunol., 1993, 91(3), 429-436</p><p>Narin N. Kutukculer N., Ozyurek R., Bakilcr A.R. 18. Lymphocyte subsets and plasma IL-t alpha, IL-2, and TNF- alpha concentrations in acute rheumatic fever and chronic rheumatic heart disease. Scand. J. Rheumatol., 1995, 24(6), 383-385</p><p>Morris K., Mohan C., W&amp;hi P.L., et al. Enhancement of IL-1, IL-2 production and IL-2 receptor generation in patients with acute rheumatic fever and active rheumatic heart disease: a prospective study. Arch. Dis. Child., 1992,67(11), 1373-1375</p><p>Zedan M.M., el-Shennawy F.A., Abou-Bakr H.M.,.al-Basousy A.M. Interleukin-2 in relation to T cell subpopulations in rheumatic heart disease. J. Rheumatol. ,1989, 16(11), 1436-1442</p><p>Насонов Е.Л., Самсонов М.Ю., Беленков Ю.Н., Фукс Д. Иммунопатология застойной сердечной недостаточности: роль цитокинов. Кардиол., 1999, 39,3, 66-73</p><p>Reid М.В., Li Y.P. Cytokines and oxidative signaling in skeletal muscle. Acta Physiol. Scand., 2001,171, 225-232 Kiemer A.K., follmar A.M. The atrial natriuretic peptide regulates the production of inflammatory mediators in macrophages. Ann. Rheum. Dis., 2001, 60, 68-70.</p><p>Deswal A., Petersen N.J., Feldman A.M. et al. Cytokines and cytokine receptors in advanced heart failure: an analysis of the cytokine database from the Vesnarinone Trial (VEST). Circulation, 2001, 103, 2055-2059</p><p>Parissis J.T., Adamopoulos S., fenetsanou K.F. et al. Clinical and neurohormonal correlates of circulating granulocyte- macrophage A9-10 colony-stimulating factor in severe heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am. J. Cardiol., 2000, 86, 707-710.</p><p>Oral H., Sivasubramanian N. Dyke D.B. et al. Myocardial proinflammatory cytokine expression and left ventricular remodeling in patients with chronic mitral regurgitation. Eur. J. Heart Fail., 2000, 2(4), 387-91</p><p>Ikeda U., Yamamoto K., Akazawa H. et al. Plasma cytokine levels in cardiac chambers of patients with mitral stenosis with congestive heart failure. Cardiol., 1996,87 (6),476-480</p></div><br />

The authors declare that there are no conflicts of interest present.