| Objective: Congestive Heart Failure (CHF) is a complex clinical syndrome and an end-stage of all kinds of cardiac disease. The incidence of CHF is high and the survival rate of 5 years is similar to that of malignant tumor, so CHF is dangerous to people's health. CHF is becoming an important issue of community sanitary in the 21 century. To explore the pathophysiology mechanism of CHF has always been a focus in medical circle. From the 1990's, ventricular remodeling has been established the essential mechanism of the processes of CHF, the activation of neurohormonal and cytokine system may contribute to ventricular remodeling and aggravate myocardial damage and cardiac function, moreover, the latter may further activate the neurohormonal and cytokine system, which developed a vicious circle. The activation of neurohormonal and cytokine system may not only impair the heart itself, but also promote the catabolism and produce the catabolic/anabolic imbalance by increasing the resting metabolic rate and peripheral oxygen consumption of the patients with CHF. It has been proved that neurohormonal and cytokine system activation was linked with weight loss and the development of cardiac cachexia. As a multipeptide hormone, leptin plays an important role in energyexpenditure and catabolism, besides, leptin is closely correlated with insulin and tumor necrosis factor-alpha (TNF-α) system. Recent study has showed the plasma leptin level was high in patients with CHF and it was speculated elevated leptin level may participate in the pathophysiologic processes of CHF. The purpose of this study was to determine the change of plasma leptin level and whether hyperleptinaemia related to insulin resistance and TNF-αsystem in patients with CHF.Methods: (1)Study subject: The CHF group consisted of 45 male patients [aged (24~78) years, mean (61.7±13.9) years] with congestive heart failure dut to valvular heart disease (n=17) or ischemic heart disease (n=16) or dilated cardiomyopathy (n=12). The diagnosis of CHF was based on Framingham standard criteria. As New York Heart Association (NYHA) cardial function criteria, symptoms were categorized as classâ…¡(n=11), class â…¢(n=18) or class â…£(n=16).Patients with a body mass index (BMI)≥25ãŽ/㎡ and patients with cardiac cachectic, hypertension, diabetes, hyperthyroidism, hepatorenal disease, cerebral vascular disease, pulmonary embolism ,malignant tumor ,connective tissue disease and infective disease were excluded from the study. Date from 30 healthy male people [ aged (23-75) years, mean (62.4±12.3) years] served as a control group, none had cardiovascular disease, pulmonary disease, renal or hepatic dysfunction and endocrine disease. There was no significant difference in age, BMI, waist/hip ratio (WHR) between two groups and there was no difference in the cases of different NYHAclass in CHF group (p>0.05). (2) Study methods: fasting venous blood was drawn and centrifuged, the separated plasma were stored at -70℃ until assay. Fasting plasma glucose (FPG) was determined using a fasting plasma glucose oxidase procedure. Plasma leptin, fasting plasma insulin (FINS) and TNF-α were measured by ELISA, insulin resistance index (Homa-IR)=ã‘(FPG×FINS/22.5). Left ventricular ejection fraction (LVEF) was measured by improved simpson method. (3) Statistical analysis: all results were presented as mean value±SEM. Two sample T tests, analysis of variance, q-test, correlation analysis such as spearman rank correlation ,pearson correlation and stepwise regression were used by SPSS10.0 software. A probability (p) value of<0.05 was considered significant. Results: (1)The plasma leptin levels in CHF group were higher compared with control group. [(6.05±1.68)μg/L vs (3.44±1.25)μg/L, p<0.001] (2)There were a increased trend of plasma leptin levels in CHF group with the increase of NYHA class .Plasma leptin levels of classâ…¡to classâ…£ were(4.41±1.22)μg/L,(5.95±1.26)μg/L and (7.28±1.39)μg/L respectively,( p<0.05 or p<0.01). Spearman rank correlation analysis showed... |
