粒细胞集落刺激因子治疗对老年慢性心力衰竭患者肾功能的影响

目的研究粒细胞集落刺激因子（G—CSF）动员内皮祖细胞（EPCs）治疗老年慢性心力衰竭（CHF）患者后对心、肾功能指标的影响，探讨其治疗效果以及对肾功能的保护作用。方法 选取40例老年CHF患者，随机分成对照组和治疗组，每组20例。对照组采用常规治疗，治疗组在常规治疗的基础上应用G—CSF，450ng／4，共5d。2组患者于治疗前、治疗后1月取外周血，分离、培养EPCs并测定其数量；同时测定脑钠肽（BNP）、尿素氮（BUN）、血清肌酐（SCr）、血清胱抑素C（cystatineC，Cys-C），采用改良后简化肾脏病膳食改良试验（MDRD）公式估算肾小球滤过率（eGFR），行心脏超声检测左室射血分数（LVEF）。结果 治疗组治疗后的EPCs数量与治疗前及对照组比较增加显著，具有统计学差异（P〈0．05）；治疗后2组BNP、Cys—C、BUN、SCr均较治疗前下降，eGFR、LVEF有提高，且治疗组优于对照组（P〈O．05）。结论 G—CSF可有效动员老年CHF患者外周血EPCs，促进其增殖和迁移，有效改善患者的症状，并对CHF患者肾功能起到保护作用。

Effects of granulocyte colony stimulating factor on the renal function of the elderly patients with chronic heart failure

Objective To investigate the cardiac and renal function of the patients with chronic heart failure （CHF） receiving the treatment of granulocyte colony stimulating factor （G-CSF） mobilized endothelial progenitor cells （EPCs） , and to explore the protective effect of G-CSF on renal function. Methods Forty cases of elderly patients with CHF were randomly divided into treatment group and control group, with 20 cases in each group. The control group received routine treatment. And the treatment group received granulocyte colony-stimulating factor （450 μg/d, 5 d）, on the basis of routine treatment. Before and 1 month after treatment, the peripheral blood was collected and the number of endothelial progenitor cells , the levels of brain natriuretic peptide （BNP）, blood urea nitrogen （BUN）, serum creatinine （SCr） , cystatine C （Cys-C）, estimated glomerular filtration rate （eGFR）, left ventricular ejection fraction（LVEF） were detected. Results Compared with the control group and before treatment, the EPCs increased significantly in the treatment group after treatment （P〈0. 05） ; After treatment, the levels of BNP, Cys-C, BUN, Scr were significantly decreased, and the levels of eG- FR and LVEF were significantly increased in the 2 groups （P〈0. 05）. The improvement in the treatment group was more significant than that in the control group （P〈0.05）. Conclusions G-CSF can effectively mobilize peripheral blood EPCs in the patients with CHF, promote cell proliferation and migration, and effectively improve the patients＇ symptoms, with protective effects on renal function in the patients with CHF.