Relationship Between Serum Androgen Level And T Lymphocyte Subsets In Male CHF Patients And Its Effect On Their Outcomes

Objective:Previous studies have shown that pro-inflammatory cytokines can accelerate cardiomyocyte apoptosis and interstitial collagen fiber degradation to produce myocardial interstitial fibrosis and adversely affect cardiac function during the development of heart failure.Cellular immune dysfunction is closely related to heart failure and can accelerate the process of heart failure.In this study,the changes of serum androgen level,T lymphocyte subsets distribution,T cell expression of human lymphocyte associated antigen(HLA-DR)and activated protein-1(AP-1)in elderly male patients with heart failure(CHF)and healthy men were compared.We analyzed their relationship with heart failure and discussed the effect of androgen on the prognosis of male patients with heart failure,and elucidated the mechanism of androgen on the protection of cardiac function from the point of view of androgen on cellular immune regulation.Methods:According to the guidelines for the diagnosis and treatment of chronic heart failure in China in 2007 as a reference,we selected 160 elderly male CHF patients admitted to the Department of Cardiology,Tianjin first Central Hospital from July 2015 to December 2017 as subjects,all patients selected by echocardiogram examination showed LVEF?45%.Forty healthy men in the same period were selected as the control group,all of them were confirmed to be healthy by cardiac ultrasound,liver and kidney function and so on.All subjects collected median elbow venous blood on an empty stomach and separated serum.The levels of serum total testosterone(TT),free testosterone(FT),dehydroepiandrosterone(DHEA),dehydroepiandrosterone sulfate(DHEAS)were measured by enzyme-linked immunosorbent assay(ELISA).Erythrocyte lysate was used to decompose erythrocytes to extract leukocytes,and whole cell lysate was used to decompose leukocytes to obtain leukocyte lysate products rich in nucleoprotein.The level of activated protein-1(AP-1)was measured by ELISA.The cells were mapped by CD3/CD4/CD8 trichromatic fluorescent monoclonal antibody.The proportion of CD3~+,CD4~+,CD8~+cells,the proportion of HLA-DR positive cells expressed by T lymphocytes were counted by flow cytometry and the ratio of CD4/CD8 was calculated.The heart failure group was followed up for 24 months and the death due to heart failure was recorded.Statistical methods:The spss16.0 statistical software was used for analysis,the measurement data were tested for normal distribution,and the normal distribution data were expressed by?x±s.Data that do not conform to normal distribution,such as CD4/CD8,conform to normal distribution after data conversion to In(CD4/CD8),and then statistical analysis is carried out.T test was used for comparison between the two groups,single factor analysis of variance was used for multiple groups,Tukey method was used for pairwise comparison,?~2test was used for counting data,univariate correlation analysis,multiple stepwise regression analysis and COX regression analysis were used.The difference was statistically significant based on P<0.05.Result:1.The age,smoking ratio,body mass index(BMI),total cholesterol(TC),triglyceride(TG),low density lipoprotein(LDL),high density lipoprotein(HDL)and hypertension in the heart failure group were compared with those in the control group.There was no significant difference between the two groups(P>0.05),but there was significant difference in atrial fibrillation and type 2 diabetes between the two groups(p<0.05,p<0.01).2.Compared with the control group,the levels of FT,TT,DHEA and DHEAS in the heart failure group were significantly lower,and showed a tendency to decrease with the deterioration of cardiac function(p<0.05,p<0.01).3.The levels of CD8,HLA-DR and AP-1 in CHF group were significantly higher than those in control group,and showed a tendency to increase with the deterioration of cardiac function(p<0.05,p<0.01).the ratio of CD3,CD4 and CD4/CD8 were significantly lower than those in the control group,and showed a tendency to decrease with the deterioration of cardiac function.4.Univariate correlation analysis showed that the levels of FT,TT,DHEA and DHEAS were positively correlated with CD3,CD4 and CD4/CD8(p<0.001);FT,TT,DHEA,DHEAS were negatively correlated with CD8,HLA-DR and AP-1(p<0.001).5.Multiple stepwise regression analysis showed that FT was independently and positively correlated with CD4/CD8,cardiac function grade was independently and negatively correlated with CD4/CD8,and FT?TT were independently and negatively correlated with HLA-DR.6.Cox regression analysis showed that FT and ACEI drug therapy were independently correlated with death during follow-up(p<0.05,p<0.01).Conclusion:1.There is hypoandrogenemia in elderly male CHF patients,the decrease of serum androgen level can affect the severity of heart failure.2.There is cellular immune dysfunction in elderly male CHF patients,the changes of T lymphocyte subsets and activity are closely related to heart failure.3.The decrease of serum androgen level in elderly male CHF patients can not inhibit the activation of T lymphocyte subsets and affect the occurrence and development of heart failure.4.Androgen affects the prognosis of elderly male CHF patients by affecting the differentiation of T lymphocytes and regulating the activation of CD4~+and CD8~+.