Plasma Adiponectin Levels And Its Correlation Study With Brain Natriuretic Peptide, Tumor Necrosis Factor-α And Insulin Resistance In Patients With Chronic Heart Failure

Background and Objective:Chronic heart failure (CHF) is a serious performance or a terminal phase in a variety of heart diseases, and is also a leading cause of death. The mortality in patients with heart failure of clinical symptoms is considerable with cancer patients in 5 years and Heart failure can be as a serious threat to human life and health. Chronic heart failure has been a major public health problem in 21 century. The current study suggests that cardiac remodeling is the basic mechanism in occurrence and development of chronic heart failure. Neuroendocrine factors system damage is associated with the process of heart failure, leading to ventricular remodeling and make myocardial injury and cardiac function deteriorate and further pathophysiological changes occure in all Systems. Excessive activation of neuroendocrine factors play an important role in the process of the pathophysiology of chronic heart failure and neuroendocrine cell factors link closely as a web. One factor change, the whole web will change. Recent studies have found that adiponectin (APN) is a plasma protein, secreted by adipose tissue.Plasma adiponectin may be involved in the pathophysiological process of heart failure. The levels of plasma adiponectin, its function and its main influencing factors have not been known clearly, it still need to be further explored in patients with chronic heart failure. This study was to determine plasma adiponectin levels and relationships with Brain Natriuretic Peptide (BNP), Tumor necrosis factor-a(TNF-a), Insulin resistance (IR) and other factors in patients with chronic heart failure and understand its main affecting factors and its predictive value in process and prognosis in heart failure. Methods:(1) subjects:90 male cases of patients with chronic heart failure were as CHF group. The average age of patients was 63.8-12.5 from 24 to 83, including ischemic heart disease 32 cases, Valvular heart disease 34 cases and dilated cardiomyopathy 24 cases. The diagnostic criteria of patients with chronic heart failure meet the Framingham, the history of disease is over 6 monthes.Left ventricular ejection fraction≤0.45 was chosen. According to the New York Heart Association (NYHA) class standard:All cases were from NYHAⅡto NYHAⅣpatients, including NYHAⅡ22cases, NYHA III 36 cases and NYHA IV32 cases. Exclude patients with other heart disease, cachexia, and hyperthyroidism, liver and kidney disease, stroke, pulmonary embolism, malignancy, connective tissue disease and other infectious diseases. Male health 90 cases were as Control group. The average age was 59.2±15.7 from 22 to 78. All cases through the physical examination and blood biochemistry, electrocardiogram, x-ray and ultrasound and other laboratory examinations, exclude respiratory, digestive, urinary, endocrine and blood system diseases. There was no significant differences in ages, blood pressure and BMI in two groups. There was no significant difference in left ventricular ejection fraction in chronic heart failure subgroups. (2) Research methods:Fasting venous blood 5ml was drawn into EDTA tubes in resting state. It was promptly placed in Centrifuge below 4℃at 3,000 r/m to separate plasma. The separated plasma in EP test was frozen at -80℃until assay. Fasting plasma glucose (FPG) was measured using oxidase test. Adiponectin and Brain natriuretic peptide were measured using an enzyme-linked immunosorbent assay system. Tumor necrosis factor-a and insulin levels were measured by radioimmunoassay.Use the formula to calculate Insulin resistance index. Home-IR= In (FPG×FINS/22.5). Left ventricular ejection fraction was measured by modified Simpson method. Use the formula to calculate Left Ventricular Mass Index, LVMI=LVM/S, LVM (g)=1.04 [(IVST+PWT+LVIDd)3-(LVIDd) 3]-13.6, S=0.0061h (cm)+0.0128m (kg)-0.1529. Calculate the incidence of the cardiovascular events and the rate of fatality in 90 patients with chronic heart failure through the follow-up in one year. (3) Statistical Analysis:Results are expressed as mean±SD for baseline characteristics. Comparisons between two groups were performed by t' test. Comparisons among groups were performed by 1-way ANOVA. Theχ2 test was used for categorical data. Correlation analysis include person correlation, spearman rank correlation and stepwise regression analysis, All values are 2 tailed, and a probability value<0.05 was considered statistically significant. The statistical software package SPSS version 13.0 (SPSS Inc) was used for all analyses.Results:(1)The levels of plasma APN were significantly higher in patients with CHF than Control group[(9.15±1.36)ug/mL vs (4.80±1.06)ug/mL, P<0.001].BNP, TNF-a and LVMI also increased significantly in CHF group(P<0.001).(2)CHF group was divided into subgroups according to the degree of heart failure, plasma APN levels tended to increase as higher NYHA class. From grade II to grade IV, the levels of APN ranged from (7.53±0.53)ug/mL,(8.81±0.37)ug/mL to (10.63±0.86)ug/mL. There was significantly difference compared with different NYHA class (P<0.001). BNP and TNF-a also increased significantly in CHF group as higher NYHA class (P<0.001). Spearman rank correlation analysis showed that plasma APN, BNP and TNF-a levels positively correlated with cardiac function class significantly (rs=0.936, rs=0.923 and rs=0.835, respectively,P<0.001).(3)There was no significant difference in plasma APN levels in patients with CHF due to different causes (P>0.05).(4)The Levels of Plasma FINS were higher in patients with CHF(P<0.001). There was no significant difference in FPG levels between two groups(P>0.05), but Home-IR was significantly different between CHF and control group(P<0.001).(5)Pearson-related analysis showed that plasma APN levels were positively correlated with BNP, TNF-a and LVMI in CHF group (r=0.528, P<0.001; r=0.255, P<0.05; r=0.269, P<0.05), while plasma APN levels were negatively correlated with Home-IR and BMI in CHF group (r=-0.456 and r=-0.400, respectively,P<0.001).(6)Stepwise regression analysis showed that BMI, BNP and Home-IR were independent indicators of APN in CHF group. Y= 11.707+0.002 (BNP)-0.12 (BMI)-0.651 (IR-home), F=33.969, P<0.001. (7) The patients with CHF were divided into high-APN group (40 persons) and low-APN group (50 persons) according to APN mean 9.15 ug/mL for the community, the incidence of cardiovascular events was 45%, and fatality rate was 32.5% in high-APN group, significantly higher than 18% and 10% in low-APN group in one year (P<0.05)Conclusion:(1)The levels of plasma APN were elevated in patients with CHF.(2)There was no significant difference in plasma APN levels in patients with CHF due to different etiology. The plasma APN levels as a common pathophysiological features were caused by the different causes in patients with CHF.(3)BNP, TNF-a, FINS and LVMI increased in patients with CHF, there exist IR and immune system activation. IR and immune system activation may affect the levels of plasma APN in patients with CHF, plasma APN may participate in the process of myocardial remodeling.(4)BNP, BMI and Home-IR were independent relevant factors to affect the levels of plasma APN in patients with CHF.(5)The levels of plasma APN were associated with the NYHA class and increased as severity of heart failure. The levels of APN predict high incidence of cardiovascular events and fatality rate, which were measured in patients with heart failure can be as a predictor in evaluation of the process and prognostic value of heart failure.