| BackgroundChronic heart failure(CHF)is inadequate cardiac output caused by ventricular systolic or diastolic dysfunction,reduced tissue perfusion,which could not meet the needs of the body,causing excessive activation of the neuroendocrine system.CHF is a complex clinical syndrome,is the end stage of various heart diseases,and has high mortality,and ventricular remodeling is an important link in the development of CHF.The diagnosis of CHF mainly depends on the clinical symptoms and signs,lack of early and specific diagnosis index,the research of specific markers of heart failure has become a hot spot in recent years.The markers have been more and more applied to early diagnosis,treatment and prognosis evaluation of CHF.Chromogranin A(CgA)is is a soluble peptide,which has the effects of inhibiting vasoconstriction?norepinephrine and endothelin,and participate in the process of ventricular remodeling.Urotensin II(UII)is the most powerful vasoconstrictor substances by far,can enhance the role of catecholamine and endothelin,angiotensin II.In recent years,the expression of CgA and U II in cardiovascular system has attracted more and more attention.ObjectiveThe purpose of this study was to explore the change of CgA and U II in patients with CHF of different cardiac function classification and pathogeny before and after the treatment,to investigate the correlation between CgA and U II,and the relationship and significance between CgA and U II before the treatment and the classification of cardiac function and ventricular remodeling index,and objective to investigate the application value and its clinical significance of chronic heart failure in children.MethodsThe 32 cases of heart failure group were selected from June 2015 to June 2016 visited in the First Affiliated Hospital of Zhengzhou University,9 cases of the center of endocardial fibroelastosis,dilated cardiomyopathy in 23 cases;the other 20 healthy children were selected as normal control group.Using enzyme-linked immunosorbent assay(ELISA)to detect the serum CgA and UII levels of the heart failure group,including before and after the treatment;using bi-directional lateral flow immunoassay to detect the N-terminal pro brain natriuretic peptide(NT-proBNP)level;echocardiography was used to measure left ventricular remodeling index.SPSS 21.0 statistical software was used for data analysis,normal distribution of measurement data using the mean and standard deviation(` X±S);non normal distribution of measurement data using the median(inter-quartile range)[M(P25,P75)].Normal distribution and homogeneous variance measurement data were compared between the two groups by t test.The LSD-t test was used between two groups of multiple comparison,and the corrected t test was used when the variance was not uniform.Non normal distribution and uneven variances,or the overall distribution of unknown measurement data of the two groups were compared using Mann-Whitney U test and comparison among multiple groups using Kruskal-Wallistest,multiple comparison between the two groups using Bonferroni method.Enumeration data were represented by the number of cases,and Chi square test was used between the two groups.Correlation analysis was performed using Pearson correlation or Spearman correlation analysis.The difference was statistically significant when P<0.05.Results(1)The serum CgA concentration and NT-proBNP concentration of the heart failure group before treatment were significantly higher than the control group(Z =-6.019,-6.019),and serum concentrations of both after treatment were significantly lower than that before treatment(Z =-4.398,-3.585);serum U II concentration is lower than the control group(Z=-5.342),after treatment,the concentration was higher than that before treatment(Z=-4.134),the differences were statistically significant(P<0.001);(2)There was no significant difference in serum CgA and NT-proBNP levels between the heart failure group with cardiac function grade II before the treatment and the control group(P>0.05).The levels of serum CgA and NT-proBNP in the patients with cardiac function grade III and IV were higher than those in the control group(P<0.05),and gradually increased with the aggravation of the degree of cardiac dysfunction(P<0.05).The concentration of U II in children with cardiac function grade II,III and IV was lower than that of control group(P<0.05),and gradually decreased with the aggravation of the degree of cardiac dysfunction,the difference was statistically significant(P<0.05);(3)There was no significant difference in serum CgA and U II levels between EFE group and DCM group(P>0.05);(4)The serum CgA concentration of the heart failure group before treatment were positively correlated with LVMI,NT-proBNP and cardiac function grade(r =0.394,0.585 and 0.720,P < 0.05),and were negatively correlated with LVEF,LVFS,and U II concentration(r =-0.599,-0.573 and-0.628,P < 0.05).The serum levels of U II were positively correlated with LVEF and LVFS(r = 0.444,0.472,P < 0.05),and were negatively correlated with cardiac function grade?NT-proBNP(r =-0.654,-0.866,P < 0.05),but had no correlation with LVMI(P>0.05).ConclusionCg A may be involved in ventricular remodeling in children with CHF;the determination of serum CgA and U II can provide a reference for the diagnosis of CHF,the classification of cardiac function and the evaluation of treatment effect of heart failure. |
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