| Objective: Chronic heart failure(CHF)is due to myocardial infarction,cardiomyopathy and other causes of myocardial damage,resulting in changes in the structure and function of the heart muscle,and finally lead to low ventricular pumping or filling function,which is the stage of serious damage to the function of myocardial cells,and also the key cause of death of patients.At present,CHF is a disease with relatively high mortality and hospitalization rate in chronic cardiovascular diseases,which has become an important problem endangering the life and health of the global public at this stage.According to clinical data,the main pathogenesis of CHF mainly covers the following four aspects: first,the change of the original substance and cardiac morphology of the heart leads to ventricular remodeling;second,myocardial remodeling;third,energy remodeling;fourth,ECG remodeling.During the development of CHF,there are many complex chronic inflammatory immune responses,in which many inflammatory cells and inflammatory factors participate.At present,many inflammatory factors,can not comprehensively evaluate the progress and severity of CHF and predict the occurrence of cardiovascular events.Human cartilage glycoprotein 39(YKL-40)is a newly discovered inflammatory mediator,which can participate in immune response,cell proliferation and differentiation,extracellular matrix remodeling and other aspects,and plays an important role in the response process.It has been pointed out that YKL-40 can be used as an independent risk factor for LVEF to reduce the prognosis of heart failure,but there are few studies on it at this stage.The changes of YKL-40 in plasma of CHF patients,the role of YKL-40 in chronic heart failure and the main influencing factors of its expression have not yet been determined,and further research is still needed.Therefore,we plan to take the relationship between serum YKL-40 and BNP,GDF-15,hsCRP as the main research direction,in order to clarify the main factors that affect the level of YKL-40 in patients with heart failure,and to measure and analyze the content of YKL-40 in the plasma of patients with chronic heart failure with different functional grades,so as to provide a more reliable theoretical basis for the evaluation of CHF by YKL-40,and provide a more reliable theoretical basis for the evaluation of CHF by chronic heart failure Diagnosis and treatment provide new criteria,and explore whether the factor can be used as an independent factor in the diagnosis of chronic heart failure,as well as its relevance to the current assessment of chronic heart failure.Methods: From January 2018 to desember 2019,90 patients with chronic heart failure were diagnosed in the Department of Cardiology of the Affiliated Hospital of Jining Medical College,Among them,51 were male and 39 were female,with an average age of 64.According to the types of diseases the patients suffered from,among them: Dilated cardiomyopathy(DCM)was 14 cases,ischemic heart disease(IHD)was 48 cases,primary hypertrophic cardiomyopathy(VHD)was 4 cases,valvular heart disease(VHD)was 16 cases,hypertensive heart disease(HHD)was 8 cases,excluding heart disease,stroke,rheumatic system disease,connective tissue disease,autoimmune disease,hypothyroidism caused by other factors Regression or hyperactivity,congenital heart disease,recent serious infection or major surgical history,etc.All cases met the diagnostic criteria of China’s heart failure guidelines in 2018.Referring to the NYHA heart failure standard classification,the course of disease of the patients was more than half a year,including 15 patients with NYHA grade II,36 patients with NYHA grade III and 39 patients with NYHA grade IV;the control group: 90 plasma samples of healthy people selected to the hospital for health examination,as well as cardiac ultrasound,with the minimum age of 23 and the maximum age of 81,The average is 63,and the proportion of men and women is 50 and 40,respectively.All of them have routine physical examination,and complete auxiliary examination to exclude patients with other system diseases.There was no significant difference in age and gender between 90 patients in CHF group and 90 healthy people in control group.Statistical processing: the data were expressed byx±s,the mean between the two groups was compared by Z test,the comparison between groups was tested by bivariate quality test,the correlation analysis was expressed by Spearson correlation coefficient,and the area under the ROC curve was expressed by the area under the curve and the accurate value.SPSS20.0 system was used for statistical analysis,P<0.05 was significant difference.Results:(1)There was no significant difference in age,weight and TG,HDL-L,LDL-L,between CHF patients in the diease of hearfailuer group and healthy patients in control group(p>0.05),but there was significant difference in SBP,DBP,HR,GLU,ALT,BUN,Cr,UA,LDH,HBDH,LVEF total bilirubin(p<0.05).(2)Plasma YKL-40’s level in patients with CHF was higher than that in the control group [(17.23±6.95105)ng/mL vs(8.7406±2.50863)ng/mL,P <0.001],the level of plasma GDF-15 in the CHF group was also significantly higher than that in the control group [27.2241±20.848vs14.2556±6.67472(P<0.001)],and the plasma hsCRP in the CHF group was higher than that in the control group(2.5722 ±2.08394vs0.7337 ± 0.59767)(P <0.001).(3)The comparison of two independent samples U test showed that the plasma YKL-40 increased with the increase of NYHA grade,and there was significant difference in plasma YKL-40 among different cardiac function grades(all P <005).(4)GDF-15 also increased with the increase of cardiac function grade(P <0.05).There was no significant difference in),hsCRP among different cardiac function grades(P >0.05).(5)YKL-40 is included in multiple regression as a dependent variable,and the regression equation YKL40=12.703+0.602*hsCRP.(6)Using Spearman: plasma YKL-40 level was positively correlated with hsCRP,BNP and GDF-15,BNP was positively correlated with GDF,and hsCRP was not significantly correlated with BNP in patients with different grades of CHF.(7)ROC curve analysis shows that the area under the curve of YKL-40 diagnosis of CHF and 95% confidence interval is 77.6%(0.706-0.846);the area under the curve of GDF-15 diagnosis CHF is 93.4%(0.895-0.974),hsCRP diagnosis CHF is 77.3%CI(0.702-0.844).Conclusion:The main results are as follows:(1)the increase of plasma YKL-40 in patients with CHF is positively correlated with the severity of heart failure,and increases with the increase of NYHA cardiac function grade,but is not affected by etiology.YKL-40,as an index of inflammation and immunity,participates in the pathophysiological process of CHF and is a common pathophysiological feature of heart failure caused by different causes.(2)There are inflammation and immune system activation in CHF.BNP,hsCRP and GDF-15 are independent related factors affecting the level of plasma YKL-40 in patients with CHF.(3)There is a correlation between YKL-40 and GDF-15 in plasma of patients with chronic heart failure.(4)To a certain extent,the level of plasma YKL-40 in patients with CHF can predict the incidence of heart failure incidences and was an important reference index to evaluate the progress and prognosis of heart failure.At the same time,GDF-15 can also predict the incidence of heart failure time to a certain extent.The combination of the two has higher reliability. |
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