| PrefaceChronic congestive heart failure is a common clinic syndrom and is the final result of various kinds of diseases. Endotheiin - 1 ( ET -1) , a potent vasoconstrictor with many kinds of function created by en-dothelial cells and myocardial cells , contribute to the pathophysiologic process of congestive heart failure. The level of plasma ET1 is not only a potent prognostic marker but also reflects the severity of the chronic heart failure. Plasma concentration of endotheiin is raised significantly in patients with chronic heart failure, correlated with haemodynamic alterations and functional impairment which means in patients with IIIN IV grade heart function, the elevation are more obvious. It is an independent marker of outcome besides haemodynemics, heart function and other hormone factors. When CHF patients were treated , plasma concentration of ET1 and mortality rate decreased. Immunoreactive ET1 also has been detected in human saliva, it xs concentration is higher than in plasma and responds to physiologic stimuli known to alter plasma endotheiin concentration. In normal subjects, plasma and salivary endotheiin concentrations which are increased with postural stress andlowered by natrichloride input paralleled plasma renin activity. In CHF patients , the markedly increased plasma level of ET1 was not further augmented by orthostatic stress, but salivary ET1 has not been tested.We investigate whether salivary ET1 concentrations in CHF patients are higher than in normal person and respond similarly to shifts in posture with plasma ET1, and if it could be used as a non - invasive marker for diagnosis and assessment of disease severity in CHF.Materials and Methods42 patients with dilated cardiomyopathy and chronic heart failure were devided by NYHAFC, 10 belong to 1,10 belong to 11,12 belong to 111,10 belong to IV. All patients were excluded from disease that might alter salivary endothelin concentrations. 15 normal person who match for age and sex belong to control group. All sample were collected in the morning, study participants fasted and lied before sampling. Collected 2ml venous blood and 2ml saliva into specially prepared tubes stored on ice. Turn to upright position for 5 minutes and collect the sample again. Immediately after completion of the protocol, samples were centrifuged at 4℃ and stored at -70℃ until the time of assay. The endothelin levels were determined by Radio - immuno assay. The experimental data were expressed by mean +s, the comparision between groups was by t - test.ResultsThe plasma and salivary endothelin levels in patients with chronicheart failure are significantly elevated compared with that in control group (p <0. 01 ) and elevated salivary endothelin levels are higher than that in plasma. There is a clear incremental increase in salivary and plasma endothelin concentrations with progression of disease severity from controls through each NYHAFC. The salivary endothelin levels in patients with chronic heart failure who belong to phase I are significantly elevated compared with that in control group. Endothelin concentration increased with upright posture in control group,but not in patients with chronic heart failure. There is a negative significant correlation between salivary endothelin concentrations and left ventricular ejection fraction in patients with chronic heart failure.DiscussionChronic heart failure is main complication of all kinds of heart disease, its clinical symptoms are lower heart output, severe retention of sodium and water with elevation of various vasoactive agents including arginine vasopressin^ plasma renin activity^atrial natriuretic pep-tide and endothelin. Many regulator contribute to the regulation of cardiovascular system in chronic heart failure; some of them are hormone in circulation, others act on original cells. They include peptides which act on local blood vessels such as endothelin,cytokines. The 21 - residue peptide endothelin, first isolated from the supernatant of cultured porcine endothelial cell... |
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