| Hepatitis C virus(HCV)is the main cause of chronic hepatitis,hepatitic cirrhosis and hepatocellular carcinoma.HCV infection not only causes various liver damage which we are familiar with,but also leads to a variety of extrahepatic manifestations.It’s reported that about 40%-76% patients of hepatitis C had at least one extrahepatic manifestation.Recent studies have reported that HCV infection can lead to myocarditis,cardiomyopathy,heart failure,atherosclerosis and other cardiovascular diseases,the heart may be the target organ that HCV infection affects.Some scholars reported that it was no correlation of two aspects.In this paper,the detection of growth differentiation factor 15(GDF-15),N-terminal pro-brain natriuretic peptide(NT-proBNP)and the observation of heart color Doppler ultrasound in 48 patients in hepatitis C virus infection are used to explore the injury of myocardio and the possible mechanism of Chronic hepatitis C(CHC).Objective: GDF-15 is one member of the transforming growth factorbeta(TGF-β)superfamily.GDF-15 biological functions are diverse,including the stimulating of cell differentiation,inducing the formation of trabecular bone,promoting the repairation of nerve cells,inhibiting the release of tumor necrosis factor and other functions,which is considered to be an endogenous protective factor.In recent years researches report that GDF-15 is associated with cardiomyopathy,congestive heart failure,atherosclerosis and so on,and is also closely related with progression and prognosis of diseases.NT-proBNP is a mainly nerve polypeptide hormone which is synthesized and secreted by ventricular muscle.When the heart function changes,abundently accumulated NT-proBNP can respond to cardiac function accurately and timely.NT-proBNP is a sensitive index of heart.Heart color Doppler ultrasound is a common method to evaluate the structure and function of the heart.In this paper,the possible damage of myocardium in patients with CHC and the possible mechanism are preliminarily discussed by detecting the above indexes.Methods:1 Subjects48 CHC patients in Hebei General Hospital from December in 2014 to December in 2015 were recruited as experimental group.38 healthy people with gender,age and BMI matched in Hebei General Hospital physical examination center over the same time were recruited as control group.Inclusion and exclusion criteria were included in all subjects.2 Detection methods:1)Record the clinical data of all subjects.After fasting,blooding samples were collected from subjects to measure HCV-RNA viral loads,liver function,blood glucose and lipid metabolism indexes.All serum samples were stored separatly,then using ELASA to detect the concentration of NT-proBNP and GDF-15.2)Two physicians in Hebei People’s Hospital ultrasound department,measured concomitantly by the application of the American General Electric Company E9 Vivid color Doppler ultrasound,M5 S probe,the frequency in 2.5~5.0MHz.All subjects were in the resting state,left lateral decubitus position,according to the standard of the American Institute of Ultrasound in Medicine.We selected left ventricular long axis as the tangent plane and measured E peak,A peak,E/A ratio,LVPW,RA,RV,EDD,EF and LA.3 Statistic analysisCompare the clinical data,serological indexes,Doppler echocardiography variables between the experimental group and the control group and respectively explore relationships between the concentration of serum NT-proBNP,GDF-15 and variables.Results:1 The comparison of cilinical data between the experimental group and the control groupPhysiological variables: The gender,age and BMI were matched between the two groups.The rate of smoking and alcohol was not statistically significant difference.The level of SBP and DBP between the two groups was not statistically significant difference.2 The comparison of blood tests between the experimental group and the control groupBiochemical variables: The level of ALT、AST、TBIL、DBIL、LDH、HBD in the experimental group was higher than those in the control group(P<0.05).The level of LDL、TC、TG and ALB in the experimental group was significantly lower than those in the control group(P <0.05).The levels of FPG between the two groups were not statistically difference.The level of serum NT-proBNP: The level of serum NT-proBNP in experimental group(145.74(453.16~27.73)ng/ml)was significantly higher than that of the control group(28.14(13.77~52.15)ng/ml),and the difference was statistically significant(P < 0.001).The level of serum GDF-15: The level of serum GDF-15 in experimental group(604.49 ± 154.03 pg/ml)was significantly higher than that of the control group(408.23 ±107.56 pg/ml),and the difference was statistically significant(P<0.001).3 The comparison of Dopple enchocardiography variables between the experimental group and the control groupThere were no significant differences for A wave,E wave,the value of E/A,LVPW,RA,RV,EDD,EF between the two groups.There were significant differences for LA between the experimental group and the control group.4 The correlation between serum NT-proBNP,GDF-15 and other variables in experimental group.1)There were positive correlations between serum NT-proBNP and age,LDL,TC,TBIL,DBIL,ALB,ChE,LA,LVPW,GDF-15(P <0.05).There were no correlations between serum NT-proBNP and other variables2)There were positive correlations between serum GDF-15 and TC,TBIL,DBIL,ALB,Ch E,LDH,HBDH,LA,LVPW,EF(P <0.05).There were no correlations between serum GDF-15 and other variables.5 Correlation analysis showed no significant correlation between serum serum HCV-RNA and LA,LVPW,EF.Conclusions:1 The levels of serum NT-proBNP,GDF-15 in CHC patients are increased significantly compared with the control group,which suggests that the CHC patients have potential myocardial damage.2 Left atrial diameter of the CHC patients in Dopple enchocardiography examination is significantly higher than that of the control group,which suggests that chronic hepatitis C patients have changes of the structure in the heart.3 The level of serum NT-proBNP in the CHC patients are negatively related to albumin,cholinesterase and positively related to total bilirubin,direct bilirubin which suggest that serum NT-proBNP shows an increasing trend with the decline of the liver function.4 The level of serum GDF-15 in the CHC patients are negatively related to albumin,cholinesterase and positively related to total bilirubin,direct bilirubin which suggest that serum GDF-15 shows an increasing trend with the decline of the liver function. |
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