| Background and ObjectivesChronic heart failure (CHF) is a kind of common ailments, frequently-occurring disease as well as a significant case of mortality. Clinical symptoms related to heart failure break out repeatedly. Recent investigations have revealed that cardiac remodeling is closely related to the mechanism of heart failure. Cardiac remodeling is characterized by cardiomyocyte hypertrophy, gradually diminishing in quantity and expression of extracellular matrix (ECM). With the development of the research of chronic heart failure, people came to be aware that heart failure progression was closely related to the cardiomyocyte reduction in amount which apoptosis was associated with. In addition, other investigations discover the relation of cardiac remodeling and apoptosis is closely connected. The over-proliferation of Cardiac fibroblasts (CFs) which have the effect of expression of extracellular matrix induces myocardial fibrosis and cardiac remodeling finally. Therefore, in the field of medical treatment of cardiovascular disease, more and more attention is given to the investigations of resist myocardial fibrosis as well as apoptosis in order to reduce incidence of disability and mortality. Recombinant human brain natriuretic peptide (rhBNP) is one of new drugs in the medical management of heart failure and it is a man-made peptide through gene engineering. Recombinant human brain natriuretic peptide has the same sequence and structure of amino acid as brain natriuretic peptide (BNP). Recent researches show that rhBNP could greatly improve symptoms of sufferers of acute heart failure in the initial stage. However, it is not reported that the curative effect of it in patients of chronic heart failure. Moreover, it is obscure that the mechanisms of rhBNP resisting cardiac remodeling. Transforming growth factor-β1(TGF-β1) is an important cytokine which is dispersed distribution and has myocardial fibrosis aggravated. Programmed cell death5(PDCD5) antibody is closely related to the development of a number of apoptosis abnormal diseases. The level of plasma PDCD5 can reflect the degree of apoptosis. This experiment observes the change of vital sign as well as plasma TGF-β1 and PDCD5 antibody in patients with decompensated chronic heart failure and the influence of recombinant human brain natriuretic peptide (rhBNP) so as to provide a basis for rhBNP resisting Cardiac remodeling.MethodsAll subjects enrolled in the study were from the first affiliated hospital of Zhengzhou university. A total number of 40 patients in NYHA heart function 4th degree (including 22males,18 females, aged 65.0±3.7 years) hospitalized in the department of geriatric medicine and cardiovascular medicine were randomly divided into two groups without family history of cardiogenic shock, contraindications to vasodilators, rupture of the heart, rupture of papillary muscle, cardiac aneurysm, the allergy to rhBNP, hepatic failure or kidney failure, serious heart valves stenosis, hypertrophic cardiomyopathy or restrictive cardiomyopathy as well as constrictive pericarditis. The two groups were rhBNP-treated group and the control group respectively. Each group consists of 20 cases. Patients in control group received conventional drug uses of diuretics, anticoagulation, angiotensin-converting enzyme inhibitor (ACEI) and plus nitroglycerin (initial dose of 5μg/min, with subsequent dose increment of 5μg/min in every 3 to 5 minutes. Patients in rhBNP-treated group were assigned to plus rhBNP (1.5μg/kg bolus intravenous injection followed by 0.0075 mg/kg/min/intravenous drop infusion) based on the control group received. The blood pressure, heart rate and frequency of respiration were observed as well as levels of plasma TGF-β1 and PDCD5 antibody from the whole subjects were measured before and after treatment at different time points by enzyme linked immunosorbent assay (ELISA).Results1. The changes of blood pressure, frequency of respiration and heart rate:There were significant differences in the decrease of blood pressure, frequency of respiration and heart rate between the rhBNP-treated group and the control group (F group=2.004, P<0.05; F time=2.304, P<0.05). Compare with the control group, the longer-lasting effects of the rhBNP-treated group on blood pressure, frequency of respiration and heart rate.2. The changes of TGF-β1 levels:There were significant differences in the value of TGF-β1among different time points in rhBNP-treated group (Ftime=585.044, P<0.001; Fgroup=40.767, P<0.001). The value of TGF-β1 in rhBNP-treated group were lower than them in control group (P<0.001). There were no significant difference of the value of TGF-β1 among different time points in control group (PTGF-β1=0.143)3. The changes of PDCD5 antibody levels:There were significant differences in the value of PDCD5 antibody among different time points in rhBNP-treated group (Ftime=23.615, P<0.001; Fgroup=35.654, P<0.001).The value of PDCD5 antibody in rhBNP-treated group were lower than them in control group (P<0.001). There were no significant difference of the value of PDCD5 antibody among different time points in control group(PPDCDS=0.28)ConclusionRecombinant human brain natriuretic peptide (rhBNP) can persistently improve the indices of blood pressure(BP),heart rate (HR), respiratory rate (RR) in patients with chronic heart failure. This may be associated with long-lasting effect of rhBNP which decrease the levels of plasma TGF-β1 and PDCD5 antibody so as to prevent cardiac fibrosis and apoptosis in cardiomyocytes. |
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