RESUMO
Objective:To investigate the changes of left ventricular mass index(LVMI),plasma brain natriuretic peptide (BNP),interJeukin-6(IL-6)and interleukin-10(IL-10)in patients with congestive heart failure(CHF),and their values in risk stratification and prognostic evaluation of CHF thereof.Methods:Ninety-five patients with CHF in accordance with 2001ACC/AHA guidelines were enrolled and stratified as stage A(n=21),B(n=23),C(n=31)and D(n=20).The levels of plasma BNP,IL-6 and IL-10 were measured and compaired with those in 20 healthy subjects(control group).The patients were followed up every three months in two years.The end point was the rehospitalization and the cardiac death.Results:(1)The level of LVMI increased early in patients with CHF at stage B.(2)The plasma BNP levels were initially elevated in CHF patients at stage B,and the concentrations of BNP closely paralleled disease severity.(3)The levels of plasma IL-6 and IL-10 were increased,and the ratio of IL-10/IL-6 was decreased,with the progression of CHF at stage C and D.The plasma BNP level was positively correlated with the levels of IL-6 and IL-10.(4)The new CHF stratification was surperior to NYHA functional classification in regard to CHF prognosis prediction.(5)Multivariate COX regression analysis showed the levels of BNP and IL-6 were the independent risk factors in prognostic evaluation(P＜0.01,P=0.026).(6)Patients in high-risk groups stratified by the combination of BNP and stage classification had obviously higher end point events rate.Conclusion:(1)LVMI was a better marker for the evaluation of left ventrieular remodeling.(2)The intrinsic mechanism of CHF progression was inflammatory reaction deterioration.(3)BNP was a good marker in predicting onset and prognosis of CHF.The combination of BNP and the stage classification could improve the prognostic evaluation in patients with CHF.
RESUMO
Objective: To investigate the effect of medication on left ventricular myocardial matrix remodeling in neuroendocrine hypertensive rats and the mechanism and inhibitive method thereof. Methods: A neuroendocrine hypertensive model was established with adult Wistar rat. A total of 34 rats were randomly divided into four groups: parzosin (Hα), cilazapril (Hace), pentoxifylline(Hptx) and hypertensive control group(Hc). Ten normal-tensive Wistar rats were used as normal control (Nc). The systemic blood pressure, serum procollagen type Ⅲ level, serum TNF-α level, collagen volume fraction(CVF) were detected. Results: In Hace group, systolic pressure, left ventricular weight, the levels of serum procollagen type III and TNF-α were all reduced obviously compared to those in Hc group(P < 0.05). In Hα group, the systolic pressure and left ventricular weight were reduced obviously compared to those in Hc group(P < 0.05), however, the levels of serum procollagen type III and TNF-α were higher than those of Nc group(P < 0.05). In group Hptx, the systolic pressure and left ventricular weight were not decreased, while the levels of serum procollagen typeⅢ,TNF-α and CVF were reduced to normal levels. Conclusion:The angiotensin coverting enzyme inhibitor is the effective agent to reverse myocardial fibrosis, which can be achieved mostly by the inhibition of AngⅡ. Pentoxifylline may inhibit and reverse myocardial fibrosis which correlated with inhibiting TNF-α.
RESUMO
Objective:To observe the correlation of platelet activation and the inflammatory factors in patients with coronary heart disease (CHD).Methods:A total of 150 patients with CHD were divided into three groups according to the guideline of ACC/AHA:Stable angina pectoris (SAP) group (n=47,aspirin 100 mg/d); Unstable angina pectoris(UAP) group (n=50,aspirin 100 mg/d+Dalteparin 5000 U Q12 h); Acute myocardial infarction (AMI) group (n=53,aspirin 100 mg/d+Dalteparin 5000 U Q12 h+Plavix 75 mg/d).53 healthy adults served as the Control group.The fast blood sugar,lipid,platelet count,platelet aggregation of plasma,fibrinogen,high sensitivity C reactive protein (hs-CRP) of plasma,and 11-dehydro thromboxane B_2 (11-DH-TXB_2) of urine were detected upon patients' admission.Results:The level of plasma hs-CRP in groups of SAP,UAP and AMI(4.25±2.95 mg/l,7.61±6.11 mg/l,15.46±8.22 mg/l)were significantly higher than that in Control group(2.07±1.28 mg/l,P<0.05).The max rate of platelet aggregation induced by ADP in groups of UAP and AMI were significantly higher than that in Control and SAP groups(74.35±8.91%,73.88±8.35% vs.66.22±7.51%,68.67±6.87%,P<0.05).There were significant differences in the max rate of platelet aggregation induced by arachidonic acid (AA) and 11-DH-TXB_2 of urine in different groups (P<0.05).The level of plasma hs-CRP in all patients with CHD were significantly positively correlated with the max rate of platelet aggregation induced by ADP (r=0.473,P=0.000),AA(r=0.434,P=0.000) and 11-DH-TXB_2 of urine (r=0.554,P=0.000).Conclusion:There were significant relationship between the levels of plasma hs-CRP,11-DH-TXB_2 and the max rate of platelet aggregation,which indicating inflammation might induce platelet aggregation in CHD patients.