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目的:评价小剂量氨甲喋呤(MTX)对充血性心力衰竭(CHF)患者血浆中各炎症递质的调节作用及其临床意义。方法:62例CHF患者(NYHA Ⅱ~Ⅳ)被随机分为 MTX治疗组(7.5 mg/周)和常规治疗组,共治疗12周,观察两组患者血浆中各炎症递质表达水平及临床病情,并与正常对照组比较。结果:①CHF患者外周血浆中各炎症递质水平均显著高于正常对照组;②MTX治疗组患者血浆中肿瘤坏死因子 α和单核细胞趋化蛋白 1的水平显著低于常规治疗组[(2.81 ±0.83)μg/L ∶(3.23 ±0.89)μg/L;(49.9 ±20.9)ng/L∶(60.4 ±17.7)ng/L,均P<0.05),而可溶性白细胞介素 1 受体拮抗剂的水平高于常规治疗组[(92.7 ±22.0) ng/L ∶(78.2 ±15.5)ng/L,P<0.05]。③与常规治疗组比较,MTX治疗组在心功能分级、生活质量、运动耐量方面可得到进一步改善,但CHF患者两组在左室射血分数及左室舒张末期直径以及重要的心血管不良事件发生率差异无统计学意义。结论:小剂量MTX治疗对CHF患者具有非特异性的免疫调节作用。
OBJECTIVE: To evaluate the regulatory effect of low dose methotrexate (MTX) on various inflammatory mediators in patients with congestive heart failure (CHF) and its clinical significance. Methods: Sixty-two CHF patients (NYHA Ⅱ ~ Ⅳ) were randomly divided into MTX treatment group (7.5 mg / week) and conventional treatment group for 12 weeks. The levels of inflammatory mediators and their clinical status in each group were observed , And compared with the normal control group. Results: ① The levels of inflammatory mediators in peripheral blood of patients with CHF were significantly higher than those in normal controls. ② The levels of TNF-α and MCP-1 in patients with MTX were significantly lower than those in patients receiving conventional treatment [(2.81 ± 0.83) μg / L: (3.23 ± 0.89) μg / L, (49.9 ± 20.9) ng / L: (60.4 ± 17.7) ng / L, all P <0.05), while soluble interleukin 1 receptor antagonist (92.7 ± 22.0) ng / L: (78.2 ± 15.5) ng / L, P <0.05]. ③ Compared with the conventional treatment group, the MTX treatment group could be further improved in the aspects of cardiac function classification, quality of life and exercise tolerance. However, the incidence of left ventricular ejection fraction and left ventricular end-diastolic diameter, and important cardiovascular adverse events occurred in both CHF patients No significant difference in rates. CONCLUSIONS: Low-dose MTX has a nonspecific immunomodulatory effect on CHF patients.