| [Background]Chronic heart failure is defined as a syndrome characterised by dysfunction of filling and ejection of left Ventricular.lt is the terminal stage of many cardiovascular disease, and has emerged as a serious medical problems.According to the2003’s survey, the incidence of chronic heart fail is0.9%across our county, while in the US, every year’s increment is upto50,000.At present,heart failure is already known as a constantly developing progress, once it occurs, cardiac dysfunction would continnuely teriorate under the influence of many kinds of pathological physiological changes.When cardic function is damaged, there occurs a variety of compensatory changes, which could maintain a relatively normal state of cardic function in a certain period of time with some negative effects emergeing.When these changes can’t keep a normal work,The situation would get more complicated. Myocardial remodeling and oxidative stress are two important promoting factors in the progress of CHF. Sympathetic system and RAAS was stimulated by the deficiency of ejection and increased chamber pressure.The stimulation of the neurohumoral mechanism could keep haemodynamic stability to some extent. But,the increase of norepinephrine (NE) in the blood have a direct toxic effect to myocardium, and can promote myocardial cell apoptosis,lead to cardiac remodeling.Meanwhile, angiotensinⅡ(ATII) and aldosterone could also cause a series of damages in myocardium,vascular smooth muscle and endothelial cells.For example,ATII could improve myocardial protein synthesis, aldosterone can help turn fiber cells into collagen fiber, witch ends in myocardial fibrosis changes. In addition, catecholamine especially its oxidation product, often leads to the oxidative stress damage, because catecholamine oxidation can produce cytotoxicity free radicals,for example,there will be a great generation of reactive oxygen specie(ROS) during the metabolism process of adrenaline.Mitochondrial enzyme system’s dysregulation can also increase ROS generation in the condition of heart failure.In conclusion,ventricular remodeling and oxidative stress in the failing state of heart are pathological reaction to hemodynamic compensation,and both of them could induce further damages to the heart.therefore,inhibiting ventricular remodeling, reducing the oxidative stress are an important means for delaying the failing of an ill heart in clinical practices.Sex hormone disorder is part of nerv-fluid imbalances in patients with failing hearts.It is already ratified that there are various kind of hormone imbalance including estrogen, dehydrogenation, androgen, etc.Estrogen is one of these already been well study and has been considered as protective factor to cardiovascular system.Compared with other sex hormone, the effect of androgen is not well explored.Recently,as the aging of the population developed,more and more evidence revealed that disorder of the male hormone in men’s body may lead to many diseases such as cardiovascular disease, metabolic disease, etc.And the observation of male patient of CHF show that gonad function deficiency are prevalent among these people.Further study found that androgen deficiency is negatively correlated with poor prognosis.androgen supplement is potential treatment to improve cardic function and alleviate symptoms.However, the specific mechanism is not clear although clinical data show that testosterone have beneficial effects to the recovery for patients with chronic heart failure.This study aims to expore the mechaanism of testosterone chronic heart failure by observing serum testosterone levels and left ventricular remodeling as well as oxidative stress.[Objective]To observe the variation of plasma level of total testosterone, malondialdehyde (MDA) and superoxide dismutase(SOD) as well as left ventricular end diastolic diameter (LVEDD) and left ventricular mass index (LVMI) in male patients with Chronic heart failure(CHF),and investigate the relationship between ventricular remodeling, oxidative stress and testosterone.[Methods]1.CHF group inovlve50inpatients with chronic heart failure from Cardiology Department in Nanfang Hospital affiliated to Southern Medical University during2010.8to2011.6.All case are indentified in according with the criteria of Framingham and then divided into3subgroups according to the New York Heart Association function class,which include21cases on classII,20cases on class111,9cases on class IV.Exclusion criteria:those who were experiencing active rheumatic heart disease,congenital heart disease,acute coronary syndrome,acute phase of cerebrovascular disease,chronic bacteria infection disease and serious damage of liver and kidney function were excluded as well as those users of sex hormone within3month. Control group included40patient with other cardiovascular diseases but without heart failure and were identified by echocardiography showing LVEF>50%.patients with serious hypertension,ACS,infection diseases,dysfunction of liver and renal were excluded.2.Collect blood samples of all patients in the next morning after hospitalization procedure and measurement of their height and weight.The samples were then processed and storage in the refrigerator at the temperature of-40℃.Detect the amount of testosterone, MDA and SOD after all specimen had been collected. all cases routinely received test of echocardiography,which is performed by two distinct doctors respectively.According to the standard plane recommended by American association of ultrasound,every patients were measured3times and took the average of LVEDd,then follow the recommended forluma to get the parameters of LVMI.3.Two independent t test was applied to analyze the difference between case group and control group.The difference among subgroups was analyzed with one-way-ANOVA. Chi-Square test was used to analyze nonparametric data. Partial correlation was applied to detect the correlationship of testosterone and other material.Pearson correlation analysis was performed to analyze the relationship between SOD,MDA and LVMI as well as LVEDd.[Results]1.Chi-Square test showed no significant difference between two groups in incidence of smoking,hypertension,diabetes and coronary heart diseases(X2=0.438、0.213.1.137.1.785;P=0.508、0.644、0.242、0.181).2. Two independent T test shows that compared with control groups,ther e is no statistical difference in ages (63.18±7.77vs60.00±8.79,t=-1.820,P=0.072). However,CHF group had significant lower levels of testosterone(7.17±3.03ng/ml vs10.19±3.99ng/ml) and SOD(64.25±2.71U/ml vs66.21±3.22U/ml) co mparaed with control one (t=4.091,3.132;P=0.000,0.002).In CHF group,it is much higher in MDA(4.66±0.40nmol/ml vs4.45±0.27nmol/ml),LVMI(150.79±9.54g/m2vs96.84±8.52g/m2) and LVEDd(55.04±4.16mm vs47.27±3.92m m) than the control(t=-2.850,-27.931,-9.018;P=0.005,0.000,0.000). 3. Difference among subgroups(NYHA-II,NYHA-III,NYHA-IV) of CHF p atients was analyzed using one-way ANOVA.There is no statisticsly significan ce in ages(63.00±8.58vs61.65±7.21vs66.60±6.72) and LVEDd(53.76±4.45mm,55.65±2.93mm,56.67±5.29mm).While,difference reveals significant in testo sterone (8.73±3.12ng/ml vs6.59±2.21ng/ml vs4.79±2.58ng/ml), LVMI(147.04±8.75g/m2vs152.19±8.38g/m2vs156.40±11.07g/m2),SOD (65.45±2.50U/ml vs63.40±2.36U/ml vs63.36±3.12U/ml) and MDA (4.49±0.41nmol/ml vs4.77±0.35nmol/ml vs4.83±0.40nmol/ml) among groups(F=7.526,3.777,3.812、3.980;P=0.001,0.030,0.029,0.025).4.After adjusting ages,Partial correlation shows a significantly negative c orrelation between LVMI,LVEDd,MDA and testosterone (r=-0.732,r=-0.629,r=-0.623;P=0.000,0.000,0.000), while a positive correlation between testosterone an d SOD(r=0.732,P=0.000) in CHF group.5.Pearson correlation shows that SOD is negatively correlated with LVMI and LVEDd(r=-0.621,-0.594;P=0.000,0.000), MDA showed no significance either LVMI (P=0.053) or LVEDd(P=0.085).[Conclusion]1.Male patients with CHF experience testosterone drop and oxidative stress imbalances as well as left ventricular remodeling. And all these pathophysiological alterations exacerbated accompanying with the deteriorating of cardic function.2.The decreased testosterone appears to be associated with greater ventricular remodeling and higher oxidative stress.3. Decreased level of antioxidants such as SOD appears to contribute to the ventricular remodeling. |
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