| BackgroundAs the third largest cause of death, cardiovascular disease is seriously harmful to human life and health. As the serious stage of the development of various heart disease, Heart failure (HF) has become the most important cardiovascular disease of this century. According to the left ventricular systolic function, heart failure can be divided into two kinds:heart failure with reduced left ventricular ejection fraction (HFREF) and heart failure with preserved left ventricular ejection fraction (HFPEF). The etiology, pathogenesis, treatment and prognosis of them are different, but the signs and symptoms of them are very similar. It is very difficult to identify those two kinds of heart failure only by clinical symptoms. Therefore finding some objective, quick, accurate indexes to guide the diagnosis and treatment of heart failure is in great need in the clinical work. Uric Acid (UA) is the final oxidation product of purine catabolism in humans. Hyperuricemia can result from increased production, increased reabsorption, or decreased clearance. Elevated blood UA levels can be used as an existence of oxidative stress and inflammation, it’s closely related with the occurrence of atherosclerosis development. Blood UA level, which is associated with mortality, can also be used as an independent predictor of poor prognosis in medium and severe heart failure. Plasma" N-terminal pro-brain natriuretic peptide(NT-proBNP) is recognized as one of the auxiliary diagnosis of heart failure, mainly synthetized and secreted by the ventricle muscle cell. Its main effect is natriuretic diuresis, the dilation of blood vessels and reducing cardiac load. The synthesis and secretion are regulated according to the tension of ventricular wall. So it can be used to judge the severity of heart failure, but is not an independent index for the judgment of the types of chronic heart failure. High-sensitivity C-reactive protein(hs-CRP), as a nonspecific inflammatory marker, is thought to be associated with heart failure, and can be used as an independent factor of prognosis.ObjectiveTo determinate plasma UA, NT-proBNP, hs-CRP level and related echocardiography indexes in patients with different clinical types of chronic heart failure and to explore the correlation of plasma Uric Acid(UA), N-terminal-pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein(hs-CRP) and left ventricular ejection fraction (LVEF) in these two groups. To further evaluate clinical value of measuring plasma UA level and plasma NT-proBNP, hs-CRP at the same time so as to offer information to determine the severity, the treatment response and the prognosis of chronic heart failure.Methods143patients with chronic heart failure were divided into two groups according to left ventricular ejection fraction(LVEF):heart failure with reduced left ventricular ejection fraction(HFREF group, LVEF≤45%, n=78) and heart failure with preserved left ventricular ejection fraction (HFPEF group, LVEF>45%,n=65). Data of plasma UA, NT-proBNP, hs-CRP level and related echocardiography indexes were obtained and compared in143patients with chronic heart failure and the normal control group(n=50). The correlation analysis were made between plasma UA, NT-proBNP, hs-CRP level and LVEF respectively in these two groups. Results1.The plasma UA in HFREF group(456.75±122.05μmol/L) was significantly higher than that in HFPEF group (394.96±122.82μmol/L, P<0.05) and control group (387.63±119.19μmol/L,P<0.05).2. Plasma level of NT-proBNP and hs-CRP in HFREF group were higher than that in HFPEF group(P<0.05), and that of both experiment groups were significantly higher than that in the control group(P<0.05).3. The UA was positively correlated with NT-proBNP and hs-CRP(r=0.649,0.532.P<0.05), and was negatively correlated with LVEF(r=-0.563,P<0.05) in HFREF group.4. The UA had no obvious correlation with NT-proBNP and hs-CRP in HFPEF group(P>0.05).Conclusion1. Patients with HFREF have higher UA level than patients with HFPEF; Plasm UA level is significantly correlated with plasma NT-proBNP and LVEF in HFREF group, and can be used as an index of the severity of heart failure.2. Plasm UA level is correlated with hs-CRP in patients with HFREF, and can be used an an indicator of oxidative stress, is closely related to the inflammatory response.3. Plasm UA level can be used as one of the effective biological parameter for the existence of oxidative stress and inflammation in HFREF, and it is of guiding significance for medicine application when combined with the measurement of plasma NT-proBNP, hs-CRP, it can also provide a basis for clinical utility in patients prognosis. |
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