| The research backgroundHeart failure(HF)is a complex cluster of clinical symptoms for the end-stage of various heart disease,mortality and re-hospitalization rates are high.In recent years,China’s population aging,hypertension,coronary heart disease,diabetes,obesity and other chronic diseases are on the rise,resulting in a continuous increase in the number of patients with heart failure,so early diagnosis and treatment of heart failure is crucial.According to the rate and time of heart failure,it can be divided into chronic heart failure(CHF)and acute heart failure(AHF).This subject temporarily discusses the changes of serum specific molecular level in patients with chronic heart failure.Ventricular remodeling is the main physiological and pathological basis of chronic heart failure occurrence and development,mainly by neurohumoral factors change,myocardial injury,and change of load caused by the extracellular matrix,myocardial cell structure and phenotype,coronary microvascular system changes,the main features of myocardial cell hyperplasia and hypertrophy,necrosis,apoptosis and fibrosis and coronary microvascular system structure and function.In recent years,the study found that neuromodulation protein 1(NRG-1)is the epidermal growth factor(epidremai growth factor,EGF)is one of the members of the family,its expression and the cardiovascular system,through a paracrine or nearly secretion pathway and tyrosine kinase ErbBs receptor activation of multiple downstream signal transduction pathways,including acyl-3-inositol phosphate kinase(PI3K)/protein kinase B(PKB/Akt)signal pathway and bax/BCL-2 signaling pathways,involved in the pathophysiological process of chronic heart failure,It plays an important role in inhibiting cell apoptosis,myocardial cell fibrosis,regulating myocardial cell structure,function,survival and proliferation.However,there are few relevant studies in China.The purpose of this study is to observe the changes of serum nrg-1 and its downstream signals AKT and BAX in patients with chronic heart failure,and to discuss its diagnostic value in chronic heart failure.PurposeThe changes of serum nrg-1 and its downstream signals AKT and BAX in patients with chronic heart failure were observed to explore its diagnostic value in chronic heart failure.MethodsA total of 92 CHF patients hospitalized in the department of cardiology of the first affiliated hospital of zhengzhou university from October 2017 to June 2018 were selected and divided into ejection fraction reduction group(HFrEF group),ejection fraction reduction group(HFrEF group),ejection fraction intermediate group(HFmrEF group),and ejection fraction retention group(HFpEF group).Color doppler ultrasound was used to measure LVEDD and LVEF,respectively.According to LVEF,the patients were divided into the group with decreased ejection fraction(LVEF<40%)(HFrEF group),the middle group(40%≦LVEF<50%)(HFmrEF group)and the group with retained ejection fraction(LVEF≥50%)(HFpEF group).In the control group,45 patients were selected who were admitted to the hospital due to atypical chest distress at the same time,but no obvious abnormalities were found by medical history inquiry,outpatient blood biochemistry and cardiac ultrasound.Fasting plasma samples of the patients were collected on the second day after admission,and general information such as age,gender,smoking and drinking history,as well as blood biochemical indicators such as total cholesterol(TC),low-density lipoprotein(LDL),alanine aminotransferase(ALT),creatinine,nt-probnp,nrg-1,AKT and BAX concentration were collected.Using SPSS21.0 statistical software for data analysis,measurement data with mean±standard deviation(x±s)said,expressed as a percentage or frequency count data,differences between the two groups to compare the t inspection or x squared,multiple sets of difference comparison between using single factor analysis of variance and SNK-t test.Correlation analysis using Pearson correlation analysis.P<0.05 was considered statistically significant.Consequence1.The age of patients in the heart failure group was greater than that of the control group,and the history of hypertension was greater than that of the control group,with statistically significant differences(P>0.05).2.Compared with the control group,nrg-1,AKT,BAX,nt-probnp,LVEDD and urea in the HFrEF group were significantly increased,respectively(1421.00±282.33)pg/ml vs(1114.37±305.11)pg/ml.(102.45±27.25)pg/ml vs(81.21±25.35)pg/ml;(11.34±2.38)pg/ml vs(9.18±2.00)pg/ml;(4003.29±3636.12)pg/ml vs(91.64±53.18)pg/ml;(68.58±9.04)mm vs(44.80±3.62)mm;(7.32±2.42)mmol/L vs(5.52±1.25)mmol/L,the difference was statistically significant(P<0.05).Nrg-1,AKT and BAX levels were not significantly different in the HFrEF group,HFmrEF group and HFpEF group(P>0.05).3.Correlation analysis showed that serum nrg-1 was positively correlated with levels of nt-probnp,AKT and LVEDD,and negatively correlated with levels of LVEF in patients in the heart failure group.Nrg-1 was negatively correlated with urea level in HFrEF patients in the heart failure subgroup.Nt-probnp was negatively correlated with LVEF and positively correlated with LVEDD and urea(all P<0.05).4.According to ROC curve,the ROC curve and AUC of serum nrg-1,AKT,BAX and urea were all greater than 0.5(with significance P<0.05),indicating that the above four indicators have certain accuracy in the diagnosis of chronic heart failure.Moreover,when the serum nrg-1 concentration was 1430.25pg/ml,the sensitivity and specificity of the prediction of heart failure were 51.1%and 86.7%,respectively,which were better sensitive and specific biochemical indicators for the diagnosis of chronic heart failure than BAX,AKT and urea.Conclusion1.The serum NT-proBNP level is significantly increased in patients with chronic heart failure,and the lower the LVEF is,the higher the NT-proBNP is.It can be clinically combined with the level of NT-proBNP to evaluate the cardiac function status,so as to further guide the treatment and prognosis of heart failure.2.Serum NRG-1 is a better reference index for the diagnosis of chronic heart failure than AKT,BAX and urea,but it still needs to be further studied to determine the degree of heart failure.3.Serum NRG-1 may be involved in regulatory processes such as inhibiting apoptosis,myocardial fibrosis and protecting myocardial cells,which is expected to be a new target for the treatment of heart failure. |
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