Value Of BNP,IL-6,IL-10 In Stritification And Prognostic Evaluation Of CHF

ObjectiveTo study the the relationship of plasmaBNP,IL-6 and IL-10 in thepatients with different stage congestive heart failure (CHF) and theventricular remodeling. In order to clarify their value in stritificationand prognostic evaluation of CHF, and to establish the method for earlydiagnosis and treatment of CHD.MethodsAccording to 2001 ACC/AHA guidelines for the newstage-classsifacation of CHF, 95 patients(49 male, 46 female) wereselected(stageA:n=21; stage B: n:22: stage C: n=31例; stage D: n=21), whowere further Subdevided as Hypertensive diease(HD) (n=33), coronaryheartdiease (CHD) (n=42), and Idiopathic dilated cardiomyopathy (IDM)(n=20)subgroups. The plasma BNP, IL-6 and IL-10 was measured and compairedwith 20 healthy subjects (control groupe) (11 male, 9 female). Allsubjects underwent UCG to measure Ventricular septal thickness(VST),Left ventricular posterior wall thickness(PWT), Left ventricular enddiastolic dimension (LVEDD), Left ventricular end-diastolic volume(LVEDV), Left Ventricular end-systolic volume (LVESV), Left ventricularejection fraction(LVEF). Plasma Brain natriuretic peptide(BNP),Interlukin-6(IL-6),Interlukin-10 (IL-10)were measured by ELISAmethod. Patients were moniterded every there months and for a follow-upperiod of one year. The end point were cardiac death or hospitalizationfor worsening CHF.Result①By two-way ANOVA, The LVMI,LVEDVI,LVEF in different stage CHFand those in normal control group are significant different. (F=109.80, 110.90, 28.42, P＜0.01). By one-way ANOVA, the LVMI,LVEDVI,LVEF ofdifferent stage CHF in diffentent subgroup and those in normal controlgroup are significant different. (HD: F=105.92, 45.60, 18.48, P＜0.01;CHD: F=117.81, 91.38, 12.30, P＜0.01; IDM: F=5.79, 4.45, 9.56, P＜0.05).Patients with high stage had higher LVMI,LVEDVI, and lower LVEF.②Bytwo-way ANOVA, the Plasma BNP,IL-6,IL-10 levels and IL-10/IL-6 indifferent stage CHF and those in normal control group are statisticaldifferent(F=112.44, 43.59, 17.25, 68.94, P＜0.01). By one-way ANOVA, theplasma BNP,IL-6,IL-10 levels and IL-10/IL-6 in different stage CHF indifferent subgroup and those in normal control group have significantdifferences(HD: F=45.52, 17.94, 9.14, 20.07, P＜0.01; CHD: F=77.25, 25.16,9.44, 52.18, P＜0.01; IDM: F=20.57, 12.96, 8.15, 19.41, P＜0.01). Patientswith high stage had higherBNP,IL-6,IL-10 levels and lower IL-10/IL-6.③By two-way ANOVA, there was no significant difference in the plasmaconcentration of BNP,IL-6,IL-10 among patients of CHF with differentunderlying heart diseases (F=0.446, 1.283, 0.509, P=0.642, 0.282, 0.603).④There were significant positive correlations between plasma BNP,IL-6,IL-10 levels and LVMI,LVEDVI,NYHA(P＜0.01), inversely with LVBF (P＜0.01).⑤The plasma BNP,IL-6,IL-10 levels correlated positively witheachother(P＜0.01).⑥The end point was the dependent variable, while theplasma BNP,IL-6,IL-10 levels and LVEF,NYHA were used as independentvariables. Logistic regression suggested the plasmaBNP and IL-6 levelswere indepegndent risk factors in prognostic evaluation.Conclusion①In early stage of CHF (stage B) the plasma BNP level was significanthigher than that of normal control group, which suggests it could be asa noninvasive biochemistry marker in the diagnosis of CHF in pro-clinicalstage. The higher patients CHF stage, the higher whose BNP level, wasindepegndent risk factors in CHF progress.②The plasma IL-6 level has no significant difference compared to that in normal control group inthe early asymptomatic stage, while was actived in the discompensatedstage of CHF, which indicated that the plasma IL-6 level was the importantmark of worsening heart function. The plasma IL-6 concentration increasedwith the progression of the stage-classification of the CHF, which wasindepegndent risk factors in CHF progress.③The rise in plasma IL-6level was not accompanied by a compensated corresponding increase ofplasma IL-10 level. Patients with high stage had lower IL-10/IL-6, whichclarified that inflammatory cytokines raised and anti-inflammatorycytokines relatively decreased in CHF patients.④There was nosignificant difference in the plasma concentration of BNP,IL-6,IL-10among patients of CHF in diffentent subgroups, which suggested thesechanges of plasma BNP,IL-6,IL-10 levels have no correlation withdifferent underlying heart diseases.⑤In the early compensated stage ofhypertention subgroup, inflammatory cytokines contrasted withanti-inflammatory eytokines raised relatively. The cause and effectrelationship between hypertion and inflammatory cytokines was to beprobed.⑥The Plasma BNP and IL-6 levels correlated positively, whichindicated neuroendocrinekines correlated with inflammatory cytokinesclosely.