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Value Of Connective Tissue Growth Factor In Diagnosis Treatment And Prognosis Of Chronic Heart Failure

Posted on:2014-01-04Degree:MasterType:Thesis
Country:ChinaCandidate:H J SunFull Text:PDF
GTID:2234330398961499Subject:Internal Medicine
Abstract/Summary:PDF Full Text Request
Purpose To study the level changes of plasma connective tissue growth factor(CTGF) in patients with chronic heart failure(CHF), analyze the correlation between CTGF and BNP, TGF-β1, LVMI and cardiac function classification in CHF patients, explore the main factors affecting the level of plasma CTGF in patients with CHF and the independent risk factors affecting the CHF, and calculate the area under the ROC curve, thus, to evaluate the value of CTGF in diagnosis, treatment and prognosis of chronic heart failure.Method According to the2007diagnosis of china for chronic heart failure guideline,111patients of CHF (males57, females54) were selected, with the history of disease being over6months. The average age of patients was (63.26±13.44) years. All patients met the New York Heart Association(NYHA) classification Ⅱ-Ⅳ grade, including NYHA II class37cases, NYHA Ⅲ class41cases, NYHA IV class33cases, who were further subdevided as Rheumatic heart disease(RHD,n=24), Hypertensive heart disease(HHD, n=26), Coronary atheroslerotic heart disease(CAD, n=35) and Dilated cardiomyopathy(DCM, n=26). Exclude patients with seriouse live and kidney diseases, acute myocardiodial infarction, congenital heart disease, hypertrophic heart disease, restrictive heart disease, cardiac tumors, pulmonary heart disease, severe endocrine disease, connective tissue disease, and patients installation of pacemaker.60volunteers(males30, females30) of healthy center were selected as control group. The average age was (60.92±12.41) years. All underwent a physical examination routinely, and were performed by blood biochemistry, ECG, chest X-ray and echocardiography to exclude people suffering from digestive, respiratory, circulatory, urinary system and other disease.Two groups were not statistically significant in regard of sex, age, BMI and liver function. All subjects were collected fasting venous blood5ml in a resting state, and was placed in EDTA-k2anticoagulant tube, then rapidly in4℃centrifuge, and centrifuged at3,000rpm/10minutes. The plasma(lml) separated was placed in EP tube and stored in-80℃freezer refrigerator under test. Plasma CTGF, BNP, TGF-β1levels were measured by the enzyme-linked immunosorbent assay; Blood biochemical indicators were detected using automatic biochemical analyzer. Left ventricular ejection fraction(LVEF), Left ventricular end-diastolic diameter(LVEDd), left ventricular end-diastolic interventricular septum thickness(IVST), left ventricular posterior wall thicness(PWT) were measured by Echocardiography, and by Devereux formula for calculation of left ventricular mass(LVM). Then the left ventricular mass index(LVMI) was calculated by LVM/body surface area(S). All date were analyzed by SPSS13.0statistical software for processing, and the value of P less than0.05for the difference was considered statistically significant.Result1. Plasma CTGF levels was significantly higher in CHF group than in control group(P<0.05); plasma BNP, TGF-β1levels and LVMI were also significantly higher in CHF group(P<0.05).2. Plasma CTGF levels gradually increased in proportion to NYHA class in CHF group, which were significantly different in subgroups(P<0.05); plasma BNP, TGF-β1levels and LVMI also increased with increasing NYHA class and were significantly different in subgroups(P<0.05).3. There was no significant difference in plasma CTGF levels among different etiology group of CHF(P>0.05); there were also no significant differences in plasma BNP and TGF-β1levels among different etiology group(β>0.05).4. Plasma CTGF levels was significantly correlated with BNP, LVMI in CHF group respectively(r1=0.540, r2=0.347, P<0.001); plasma CTGF levels was not significantly correlated with TGF-3,(r=0.052, P>0.05).5. The relationship between plasma CTGF levels and NYHA class in CHF group(1) Univariate analysis:plasma CTGF levels was significantly correlated with NYHA class in CHF group(r=0.384,P<0.001);plasma BNP and TGF-β1levels and LVMI were positively correlated with NYHA class respectively(r1=0.491, r2=0.442, P<0.001).(2)Multivariate analysis:take the numerical NYHA class as dependent variable, to analyze from the following three aspects:①Take all indicators including CTGF and BNP as independent variables, and put them into a multiple regression model, the following regression equation is Y(NYHA)=2.252-0.143(LDL-C)-0.031(LVEF)+0.017(BNP)+0.005(LVMI)+0.001(TGF-β1)+0.001(CTGF)(R2=57.3, F=22.769, P<0.05), showing that plasma CTGF and BNP combined with other clinical indicators could explain57.3%of the variation of heart function.〦xcluding the indicator CTGF, take the remaining indicators including BNP as independent variables, and put them into a multiple regression model, the following regression equation is Y(NYHA)=2.668-0.140(LDL-C)-0.030(LVEF)+0.024(BNP)+0.006(LVMI)+0.001(TGF-β1)(R2=54.3, F=24.494, P<0.05), showing that plasma BNP combined with other clinical indicators could explain54.3%of the variation of heart function.③Excluding the indicator BNP, take the remaining indicators including CTGF as independent variables, and put them into a multiple regression model,the following regression equation is Y(NYHA)=2.201-0.144(LDL-C)-0.031(LVEF)-0.058(FBS)+0.007(LVMI)+0.001(TGF-β1)+0.001(CTGF)(R2=55.6, F=21.331, P<0.05), showing that plasma BNP combined with other clinical indicators could explain54.3%of the variation of heart function.6. BNP and NYHA class were independent factors affecting plasma CTGF levels in CHF group(P<0.001).7. Plasma CTGF and BUN were independent risk factors for CHF, the impact of CTGF is OR=1.005,95%C7(1.002-1.008).8. ROC curve analysis:take BNP, CTGF as test variables respectively, and CHF as the state variables, put them into the ROC curve analysis model, the area under ROC curve of BNP is87.3%(P=0.000),95%Cl(0.819-0.927); the area under ROV curve of CTGF is74.7%(P=0.000),95%Cl(0.674-0.820), indicating that the value of plasma CTGF in diagnosis of CHF was partly approaching to BNP.Conclusion1. Plasma CTGF levels is significantly higher in patients with CHF, which is independent of heart failure etiology, and is a common pathophysiological characteristics for different causes of CHF.2. Plasma CTGF levels of patients with CHF is correlated with the severity of heart failure, and can more accurately reflecct the variation of cardiac function, indicating that CTGF has a certain value in the diagnosis of heart failure.3. CTGF is an independent risk factor of heart failure, and its plasma levels correlates with the degree of cardiac remodeling, suggesting that plasma CTGF has a certain significance to guide clinical treatment and determine prognosis4. CTGF is more specific potential target for anti-fibrotic therapy, and can provide new idears for the treatment of CHF.
Keywords/Search Tags:Chronic heart failure, Connective tissue growth factor, Brain natriureticpeptide, Transforming growth factor-β1, Left ventricular mass index
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