The Changes And Significance Of Serum Type ? Procollagen Carboxy-terminal Propeptide And Type ? Procollagen Amino-terminal Propeptide In Children With Chronic Heart Failure

BackgroundChronic heart failure(CHF)refers to the fact that the heart cannot provide enough cardiac output to meet the needs of the body's metabolism and receive enough venous return for a long-term.It is the end stage of many cardiovascular diseases.CHF in children is one cause of children mortality and morbidity,which brings heavy burden to family and society.The diagnosis of heart failure is mainly based on clinical symptoms.Although echocardiography is a powerful tool for the diagnosis and evaluation of heart failure,it still has defects.The widespread use of BNPs in the clinic has made doctors to see the value of cardiac dysfunction indicators.But their sensitivity and specificity is low,so in recent years,more researches about circulating markers of CHF were published.Myocardial fibrosis is the basis of left ventricular myocardial remodeling,which is the key to chronic heart failure.The collagen fibers in the extracellular matrix(ECM)of myocardium are mainly composed of type ? and type ? collagen.the carboxy-terminal propeptide of type ? procollagen(PICP)and the amino-terminal propeptide of type ? procollagen(PIIINP)are decomposed during the production of collagen fibers.Fragments are closely related to type I and type III collagen fibers.A large number of studies have shown that serum PICP and PIIINP levels are elevated in patients with CHF,but there have been fewer studies in children with heart failure.In this study,the level of serum PICP and PIIINP in children with CHF and their relationship with ventricular remodeling index are detected The clinical value of them in children with chronic heart failure was analyzed.MethodsFrom October 2017 to October 2019,40 children with CHF diagnosed in pediatric cardiovascular department of the First Affiliated Hospital of Zhengzhou University were included as heart failure group.According to the primary disease,23 cases were divided into dilated cardiomyopathy group and 17 cases into endocardial elastosis group.According to the cardiac function classification,there were 12 patients in the NYHA stage ? heart failure,15 patients in the NYHA stage?,and 13 patients in the NYHA stage ?.Another 20 healthy children who were treated in the pediatric clinic of the First Affiliated Hospital of Zhengzhou University during the same period were selected as the control group.There was no statistical difference in age,sex and other general data of each group(P<0.05).The levels of PICP and PIIINP in serum and NT-proBNP in plasma were detected by ELISA and radioimmunoassay,respectively.Echocardiography was used to detect the left ventricular ejection fraction,left ventricular shortening fraction,left ventricular end-diastolic diameter,left ventricular posterior wall thickness,and end-diastolic ventricular septal thickness,SPSS25.0 statistical software was used to analyze the experimental data.The measurement data of normal distribution is represented by mean ± standard deviation,and the comparison of measurement data between groups is represented by independent t-test and one-way ANOVA;the measurement data of skew distribution is represented by median(interquartile interval),the comparison between groups is represented by Kruskal-Wallis test,and Bonferroni correction was used for pairwise comparison between multiple groups.The counting data is represented by the number of examples,and the 2-test is used for component comparison.Association analysis was performed using Spearman rank correlation analysis.The difference was statistically significant when the P value was less than 0.05.Results1.The levels of serum PICP and P?NP and plasma NT-proBNP in children with heart failure were higher than those in the treatment group.The levels of serum PICP and P?NP and plasma NT-proBNP in patients with heart failure were higher than those in the control group.The difference was statistically significant(P<0.05).2.Compared with the control group,the levels of serum PICP?P?NP in the heart failure group of NYHA stage ? and ? was significantly higher(P<0.05),and increased with the deterioration of heart function.There was no statistical difference in the levels of serum PICP and PIIINP in the heart failure group of NYHA stage ? and ? compared with the control group(P>0.05).3.There was no significant difference in the levels of PICP and P?NP between DCM and EFE groups(P>0.05).4.The levels of PICP and PIIINP were positively correlated with each other before treatment in children with heart failure(r=0.71,P<0.05);the levels of PICP were positively correlated with cardiac function,NT-proBNP levels,LVEDd,and LVM(r=0.53,0.4,0.3,0.27,P<0.05),negatively correlated with LVEF and LVFS(r=-0.50,-0.44,P<0.05);the levels of P?NP were positively correlated with cardiac function,NT-proBNP levels,and LVEDd(r=0.51,0.44,0.32,0.27,P<0.05),and negative correlation with LVEF and LVFS(r=-0.52,-0.48,P<0.05).Conclusion1.PICP and P?NP take part in the occurrance and development of myocardial fibrosis in children with CHF.2.Serum PICP and P?NP levels can help diagnose heart failure of children,grade heart function,and evaluate the treatment effect of CHF.