| Background and ObjectiveHeart failure(heart failure,HF)is a complex clinical syndrome.Any heart disease that causes structural or functional abnormalities leads to ventricular filling disorder or reduced cardiac output in a resting or stress state that cannot meet the metabolic needs of the body The pathological state.Heart failure may be caused by myocardium,endocardium,pericardium,heart valves,blood vessels,or metabolic diseases.Most children with heart failure have symptoms of impaired left ventricular myocardial function.Heart failure is one of the critical illnesses in childhood.The diagnosis of heart failure in children is based on clinical symptoms,signs,auxiliary examinations(including exercise tests,non-invasive imaging tests)and biomarker analysis.Clinical manifestations are still the main basis for diagnosis.There are not many specific experimental indicators for early diagnosis,so it is extremely important to find new biomarkers for heart failure for early diagnosis,prognosis and treatment effect evaluation.Pentraxin-3(PTX-3)is an inflammatory marker that participates in tissue remodeling and repair,and may help determine the diagnosis and prognosis of children with heart failure.Syndecan-4(syndecan-4,SDC4)regulates the phenotype and function of cardiac fibroblasts,collagen cross-linking and myocardial fibrosis,and may be involved in myocardial remodeling.Previous studies have shown that serum PTX-3 and SDC-4 levels are elevated in adult patients with chronic heart failure,but there are fewer studies on them in children with chronic heart failure.In this study,the changes in serum levels of PTX-3 and SDC-4 in HF patients before and after treatment,different primary diseases,and different levels of cardiac function and their correlation with cardiac remodeling indicators were examined to explore the diagnosis and diagnosis of children with CHF.The application value of disease assessment.MethodsFrom June 2018 to September 2020,50 children diagnosed with CHF in the First Affiliated Hospital of Zhengzhou University were selected as the heart failure group.According to the different primary diseases,they were divided into 22 cases of dilated cardiomyopathy(DCM)group,13 cases of myocardial insufficiency(NVM)group,and 15 cases of endocardial elastofibrosis(EFE)group;according to the difference before and after treatment,Children with heart failure are divided into pre-treatment and post-treatment groups;according to different cardiac function classifications,they are divided into heart function class Ⅱ,heart function class Ⅲ,and heart function class Ⅳ group.Infants and young children’s heart function classification adopts modified Ross According to the score,16 cases were in the central function group Ⅱ,17 cases were in the heart function group Ⅲ,and 17 cases were in the heart function group Ⅳ.In addition,30 children in outpatient physical examination during the same period were selected as healthy control group.There was no significant difference in age and sex between children with heart failure in each group and healthy children in the control group(P>0.05).Enzyme-linked immunosorbent assay was used to detect serum levels of PTX-3,Syndecan-4,and NT-proBNP.Echocardiography measures left ventricular ejection fraction(LVEF),left ventricular short axis shortening rate(LVFS),end diastolic ventricular septal thickness(IVST),end diastolic left ventricular posterior wall thickness(PWT),left ventricular end diastolic diameter(LVEDd)and other cardiac-related indicators.Use SPSS26.0 statistical analysis software to perform statistical analysis on the experimental data.The measurement data conforming to the normal distribution are represented by the mean ± standard deviation,and the comparison of the measurement data between groups uses the paired t test and one-way analysis of variance;the measurement data of the skewed distribution is represented by the median M(P25,P75),Paired samples were compared between the two groups by Wilcoxon signed-rank test,independent samples were compared by Mann-Whitney U test between two groups,nonparametric Kruskal-Wallis H test was used for comparison between multiple groups,and Nemenyi method was used for pairwise comparison between multiple groups.Spearman rank correlation was used to analyze the correlation between PTX-3,SDC-4 and NTpro-BNP,LVEF,LVFS,LVEDd and LVMI.The difference is statistically significant with P<0.05.Results1.Serum levels of PTX-3,SDC-4 and NT-proBNP in children with CHF were significantly higher than those after treatment and the control group before treatment,and higher than those in the control group after treatment,the difference was statistically significant(P<0.05).2.The levels of serum PTX-3 and SDC-4 in the heart failure group of children with heart function grades Ⅱ,Ⅲ,and Ⅳ were higher than those of the healthy control group.The worse the heart function,the higher the concentration,and the difference was statistically significant(P<0.05);Compared with the cardiac function grade Ⅱgroup,the serum PTX-3 and SDC-4 levels were significantly higher in the cardiac function group Ⅲ,and the difference was statistically significant(P<0.05).3.There was no significant difference in serum PTX-3 and SDC-4 levels among children with DCM,NVM and EFE(P>0.05).4.The serum PTX-3 and SDC-4 levels of children in the heart failure group were positively correlated with each other before treatment(r value=0.967,P<0.05);serum PTX-3 levels were positively correlated with NT-proBNP,LVMI,and cardiac function classification(r value=0.772,0.782,0.941,P<0.05),which was negatively correlated with LVEF and LVFS(r=-0.847,-0.785,P<0.05);serum SDC-4 level was correlated with NT-proBNP,LVMI,heart Functional classification was positively correlated(r value=0.797,0.803,0.942,P<0.05),and negatively correlated with LVEF and LVFS(r value=-0.814,-0.774,P<0.05),serum PTX-3,SDC-4 levels were not significantly correlated with LVEDd(P>0.05).Conclusions1.PTX-3 and SDC-4 promote the development of chronic heart failure in children.2.Serum PTX-3 and SDC-4 levels may provide laboratory indicators for the diagnosis of chronic heart failure in children,the classification of cardiac function and the judgment of treatment effects. |
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