| Objective: Congestive heart failure (CHF) is a complex syndrome including hemodynamic, neurohumoral and metabolic abnormalities, which is a severity stage of many cardiac disease. How to diagnose CHF and assess the cardiac function level is related to the treatment and prognosis of CHF. Adiponectin (APN ) is a recently discovered adipocyte-specific protein that is coded by gene apM1 highly expressed in white adipose tissue. At present, part of physiological function of APN has been learnt. It plays a role in regulating insulin sensitivity, lipid metabolism, and systemic inflammation. The plasma APN level is decreased in persons with obesity, type 2 diabetes mellitus, dyslipidemia, hypertension, metabolic syndrome and ischemic heart disease. Recent studies have indicated that the plasma APN level is increased in CHF patients, but the mechanism through which APN production from adipose tissue is stimulated by CHF has not been elucidated. Brain natriuretic peptide (BNP) is a peptide hormone. BNP secretion by the ventricular myocardium reflects the elevation of intracardiac pressure. Similarly, many studies showed that the plasma level of BNP are important for diagnosis and prognostic predictor of CHF.The aim of this study was to evaluate the relationship between the plasma APN level, plasma BNP level, and cardiac function in CHF patients, and to detect whether the levels of the plasma APN and BNP are decreased after treatment .Methods: The levels of plasma APN and BNP were measured by enzyme-linked immuneosorbent assay(ELISA) in 70 before treatment and after treatment(using ACEI, the aldosterone receptor antagonist,β-receptor blockers, diuretics and so on, improvement in cardiac function for at least one) patients with congestive heart failure of dilated cardiomyopathy and 20 control subjects respectively. These patients included 42 male patients and 36 female ones, with average age of 62±13.6 years old, all of them were accordant with the diagnosis criterion of CHF from America Heart Disease Association. The patients came from the in-patient department of 2th hospital with the Hebei Medical University. NYHA (New York Heart Association)Ⅱ: 18, NYHAⅢ: 30, NYHAⅣ: 22. Another 20 control subjects came from out-patient department, including 9 male healthy persons and 11 female ones,with average age of 53±9.9 years old. All subjects not only had excluded body mass index (BMI)≥25kg/m2 and BMI<18.5 kg/m2, but also had no other diseases such as infection, tumour, systemic autoimmune diseases, acute cerebrovascular disease, pulmonary embolism, hypertension, chronic obstructive pulmonary disease, hepatic insufficiency, renal insufficiency, acute coronary syndrome, TZD staking patients, metabolic disease (diabetes, hyperthyreosis) and other angiocardiopathy.Taking ulnar venous blood 2ml on an empty stomach, infusing anticoagulation tube, using centrifugal machine, 3000/min, centrifuging 10 minutes, the plasma in Eppendorf was preserved in -80℃refrigerator. The levels of adiponectin and BNP in all specimens were measured after collection respectively.Continuous variables were expressed as the mean value±standard deviation (SD), Comparisons of the plasma levels of adiponectin and BNP between the CHF group and controls group were conducted by independent-samples t-test, and one-way ANOVA of variance was used for the comparision between the subgroups of the CHF. Paired-samples t-test was performed to compare differences between before and after treatment of the subgroups of the CHF. Pearson's correlation coefficient method was used for linear correlation analyses of adiponectin level and BNP level in patients with CHF. A value of P<0.05 was considered signifieant. All data analyses were performed using SPSS13.0.Results: 1 The age, sex, BMI showed no difference among these subjects.2 The plasma levels of adiponectin (11.66±4.59mg/L) and BNP (1079.78±550.76pg/ml) in CHF patients before treatment were significantly higher compared with those in control subjects (1.38±0.47 mg/L, 59.63±22.43pg/ml) (P<0.01).3 The plasma levels of adiponectin in NYHA function classⅡtoⅣsubgroup in CHF group (classⅡ5.59±1.85mg/L, classⅢ11.27±3.00mg/L, classⅣ15.19±3.81mg/L) increased with the severity of NYHA functional class (P<0.05).The plasma levels of BNP in NYHA function classⅡtoⅣsubgroup in CHF group (classⅡ463.78±169.50pg/ml, classⅢ917.05±290.19pg/ml, classⅣ1595.72±481.76pg/ml) increased with the severity of NYHA functional class (P<0.05).4 The plasma levels of adiponectin (11.66±4.59 mg/L) and BNP (1079.78±550.76pg/ml) in CHF patients after treatment were lower than those before treatment (5.88±2.55mg/L, 8.03士2.64mg/L) (P<0.01).5 The plasma levels of adiponectin in NYHA function classⅡtoⅣsubgroup in CHF group after treatment (classⅡ3.81士1.33mg/L, classⅢ4.99士1.42mg/L, classⅣ2502.71士1180.96 pg/ml) were lower compared with those before treatment (classⅡ337.47士101.86pg/ml, classⅢ11.27±3.00mg/L, classⅣ15.19±3.81mg/L); The plasma levels of BNP in NYHA function classⅡtoⅣsubgroup in CHF group after treatment (classⅡ337.47士101.86pg/ml, classⅢ457.48士133.87pg/ml, classⅣ768.31士210.23pg/ml) were lower compared with those before treatment (classⅡ463.78±169.50pg/ml, classⅢ917.05±290.19 pg/ml, classⅣ1595.72±481.76pg/ml) (P<0.01).6 There was a significant positive correlation between the plasma levels of adiponectin and BNP in CHF patients ( r=0.68,P<0.01).Conclusions: The plasma levels of adiponectin and BNP in CHF patients before treatment were significantly higher compared with those in control subjects. Moreover, they increased with the severity of NYHA functional class and had closed relation with the occurrence and evolution of CHF. The levels of plasma adiponectin and BNP in CHF patients decreased after treatment. Meanwhile, There was a significant positive correlation between their plasma adiponectin and BNP levels. BNP has been recognized as a plasma marker of heart failure, and APN in cardiovascular protection has been widely reported.They were showed that APN can be used as a new plasma marker of heart failure to diagnose and determine the efficacy of CHF.
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