The Study Of ADM And CNP In Children With Chronic Heart Failure

Objective Heart Failure is a common urgent and critical disease in children. With the mechanisms of neuroendocrines being studied deeper, it have found that many neuroendocrines overexcitation and vascular remodeling may be factors of development in the patients with chronic heart failure(CHF). The levels of many kinds of polypeptides elevate significantly in patients with CHF, and suppose that these polypeptides may participate in the pathophysiology of CHF. In recent years, many studies have indiced that ADM is a diagnosis indicator and a preditor of prognoss of CHF, and moreover played a indicative role of the treatment in adult. However there are few studies on this subject in children, The main aim of this experiment is to investigate the changes of ADM and CNP in children with CHF, in order to discover the role of ADM and CNP in CHF, to evaluate the utility of ADM and CNP in diagnosing CHF; to observe the correlation of the changes in levels ADM and CNP and the severity of CHF and the cardiac parameters, in order to find a new biochemical marker for evaluating the severity of CHF and predicting prognosis of CHF, to investigate the changes of pathophysiology of CHF in children.Methods Blood sumples were collected from 42 children with CHF, 16 children with in class II ,14 in class III , 12 in class IV before treatment and 7 inclass IV after treatment; 11 healthy children were normal controls. The levels of ADM and CNP were measured by specific radiommunoassay. Echocardiography was performed to measure left ventricular function and the ratio of E/A. The cardiothoracic ratio was measured by reontgennography. Statistical assay: Results were reported as mean±SD(.v±5 ). The data were treated with SPSS 10.0 statistical software.Results l.The contrast in the ADM levels: before treatment the level ofADM in CHF was218.27±106.53pg/ml , in class II 151.74±73.27 pg/ml, in classIII214.88±81.44 pg/ml, in classIV310.93± 106.42 pg/ml. after treatment the levelof ADM in class IIwas81.56±32.48 pg/ml , in class III 115.95±65.89 pg/ml , inclassIV157.29±66.42 pg/ml . the level of ADM in controls was74.39±53.99pg/ml.Plasma ADM concentration in CHF patients with each classification (II, III and IV)was significantly higher than in control subjects {P <0.05, respectively).In addition,the plasma concentration of ADM was increased with advancing class of CHF.Thelevels of ADM after treatment were much lower than those before treatment(P<0.01). 2.The contrast in the CNP levels: before treatment the level of CNP inCHF wasl90.27±108.38 pg/ml, in class II 145.65±62.81 pg/ml, in classIII182.20±93.56 pg/ml , in classIV259.18±141.06 pg/ml . after treatment thelevel of CNP in class II was97.04±34.21pg/ml,inclassIII101.14±21.53 pg/ml, inclassIVl22.25±59.29 pg/ml . the level of CNP in controls was 92.59±59.46 pg/ml.Though the plasma levels of CNP were increased with advancing class of CHF,there were no significant difference in plasma levels of CNP between class III andclass II, between class II and controls . The levels of CNP after treatment were muchlower than those before treatment (P <0.01). 3.The levels of the parameters ofcardiac function in CHF: the levels of LVEF in CHF patients was 38.36±13.58 %.the levels of FS in CHF patients was 23.35±8.68% . the levels of E/A in CHFpatients was 1.54±0.16. the levels of CTR in CHF patients was 0.58±0.06. The levelsof LVEF and FS were significantly dereased in proportion to the severity of heartfunction classification (P <0.01,respectively). The levels of CTR was significantlyincreased in proportion to the severity of cardiac function classification (P<0.01,respectively). The levels of E/A was significantly higher in class IY(1.39±0.12) as compared with class II (1.63±0.11, P <0.01) and class III (1.57±0.14, P <0.05). There was no significant difference in E/A between class Hand class l\\(P >0.05) 4. Correlativity assay: (1) A significant correlation of plasma ADM level with LVEF (r=-0.69, PO.001), E/A( r=0.34, PO.01), FS( r=-0.67, PO.001) and CTR (r=0.77, P<0.001) was observed. (2)A significant con-elation of plasma CNP level with LVEF( r=-0.48, PO.001), FS( r=-0.47, P<0.001) and CTR( f=0.46, P <0.01) was observed. But there no relationship between CNP and E/A( r=0.27, P>0.05). (3) There was a significant positive correlation between the levels of ADM and CNP in the patients with CHF (r=0.43, P=0.005). There was no relationships between them in the controls (r=0.34, P =0.31). (4) There was significant positive correlation between the levels of ADM and the severity of CHF (r=0.62, P=0.000). But the severity of CHF was shown to be slight positive conrelationship with plasma CNP levels (i=0.36, P=0.019). 5. The diagnostic valure of ADM and CNP in CHF: The area under the receiver operating charcteristic(ROC) curve, which determines the diagnostic accuracyof ADM in CHF , was 90.3% (PO.01); the area about CNP was 75.5% (PO.01). ADM level of 92.65 pg/ml had sensitivity of 92.9°/^ specificity of 81.8%% positive predictive of 95.1%> negative predictive of 75% and Youden index of 74.7% for diagnosing CHF. CNP level of 11.6.07 pg/ml had sensitivity of 76.2%> specificity of 72.7%^ positive predictive of 91.4%s negative predictive of 44.4% and Youden index of 48.9% for diagnosing CHF. Both of the indices, ADM had the highest sensitivity, specificity, positive predictive, negative predictive, Youden index and accuracy.Conclusions 1. The levels of ADM and CNP are increased significantly in children with CHF compared with healthy children, and were significantly increased in proportion to the severity of cardiac function classification , and the levels of them after treatment were much lower than those before treatment. They may play pathophysiological roles in CHF and can act as biochemical marker for indicating the treatment of CHF. 2. Compare with CNP, ADM plasma levels were significantly positively associated with the severity of CHF and the cardiac functionparameters. ADM may act as a biochemical marker for evaluating the severity of CHF and an indenpent predictor of prognosis and a diagnostic director of CHF in children. 3. The coiTelationship between ADM and CNP in the development of CHF was still unclear. It needed more deep investigation. 4. The results of this experiment can primarily investigate the changes and effect of neuroendocrines inchildren, but it needs deep research to manifest the mechanisms.