The Levels Of Serum Cytokines And Left Cardiac Function In Patients With Chronic Renal Failure

objective To investigate the changes of serum interleukin-lbeta(IL-1β) , interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α ) and left cardiac structure and function in patients with chronic renal failure and the relationship between them . Methods Double antibody sandwich ELISA was used to determine serum IL-1β , IL-6 and TNF-α levels in 22 cases of control ( Group A ) , 22 cases of renal insufficiency compensated (Group B), 25 cases of azotemia (Group C), 26 cases of renal failure (Group D), 23 not yet dialyzed patients of uremia (Group E). The left atrium enddiastolic diameter(LADd) , left ventricular end diastolic diameter(LVEDd) , left ventricular end systolic diameter( LVEDs ) ,interventricular septum thickness ( IVST ) , left ventricular posterior wall thickness (LVPWT), left ventricular ejection fraction (LVEF), left ventricular fraction shortening(LVFS), early mitral in flow peak velocity (E), atrial mitral inflow peak index (A), and ratio of E to A (E/A) were assessed by echocardiogram in them . Result ① TNF-a level in Group E was obviously higher than that in Group A> Group B, Group C and Group D ( P<0. 05) . Compared with Group A, Group B and Group C, the leves of IL-6 and IL-1 P in Group D and Group E were significantly elevated ( P<0.05).With endogenetic creatinine clearance rate (Ccr) increased , the levels of TNF-a , IL~6 andIL-1Pwere decreased. Among these cytokines, TNF-a and IL-1P were influence factors of Ccr. While the levels of TNF-a and IL-1 P were elevated Ccr was reduced. ②Compared with Group A and Group B, LADd, LVEDd, LVEDs, ILST, LVPWT were increased significantly( P<0. 05), and LADd, ILST in Group C began increasing obviously( P<0. 05). Compared with Group A, LVEF was decreased strongly in Group E( P<0. 01). Peak A was increased obviously and E/A had significant difference in Group D and Group E( P<0. 01). LVEF and LVFS in Group D and Group E were significantly decreased compared with Group B ( P<0. 01). ③ The mean values of IL-6 and IL-1 P in patients with cardiovascular complications in Group D and Group E were higher than the non-cardiovascular complications patients(P<0. 05). In this study, the factors which influenced LVEF were IL-1P and TNF-a , and with their levels increased , LVEF was decreasd. The factor which influenced E/A was IL-6,and with its level elevated, E/A was reduced. Conclusion (1) There existedchronic inflammatory reaction in CRF patients with signs of increased levels of cytokines (such as 11,-1 P , IL-6 and TNF-a etc. ) , and inflammatory cytokines were the important risk factors which can accelerate chronic renal failure. (2) Patients with CRF were usual complicated by left ventricular hypertrophy and left cardiac dysfunction, and the prevalence of left cardiac diastolic dysfunction were higher and occurred earlier. (3) A synergism of inflammatory cytokines in CRF patients could promote and deteriorate cardiac dysfunction .