On Congestive Heart Failure and Sympathetic Nervous System Activation
|Keywords||heart failure catecholamine B-blocker|
Background and purpose：Congestive heart failure is extremely commonclinical critically ill patients, most patients with structural heart disease isalmost inevitable outcome, or death from cardiovascular disease the mostimportant reason, its high prevalence and low survival rate, patients with poorquality of life, becoming a social and public health issues can not be ignored.Its pathophysiological changes are complex, including the activation of theneuroendocrine system, the hypertrophy of myocardial cells into the activationof fibroblast proliferation and fibrosis, inflammatory factors, impairedmitochondrial function. Among them, activation of the neuroendocrine systemis an important biological characteristics of congestive heart failure, but alsocardiac function progress, deteriorating infrastructure. At the same time, a lot ofliterature show that the sympathetic nervous system activation plays animportant role in the development and progression of congestive heart failure,may be an important factor in patients with congestive heart failure diseaseprogression. This study, patients with congestive heart failure plasmaepinephrine, norepinephrine analysis to explore the correlation between heartfailure patients with plasma catecholamine levels and heart function. Methods:2011.1-2011.7Department of Cardiology at the Sino-Japanese FriendshipHospital of Jilin University, has made it clear diagnosis of56cases of chronicheart failure, according to the cardiac function is divided into three groups,each group was divided into before and after treatment in two subgroups.Exclusion criteria:(1) the recent unstable angina pectoris and acute myocardialinfarction (3months);(2) acute and chronic infections, inflammatory diseases;(3) patients with autoimmune diseases;(4) obvious liver and kidney dysfunction;(5) of rheumatic diseases, recent rheumatic activity (three months);(6) diabetes, hyperthyroidism or other endocrine diseases;(7) affect theimmune response to drugs (such as the recent corticosteroids) are;(8)pregnancy; cancer patients；(9) the New York Heart Association functionalclassification is a classification scheme in1928, the New York HeartAssociation (NYHA), mainly according to the activities of conscious patientscapacity is divided into four levels: level I: patients suffering from heart disease,but activity without restriction, usually general activities do not cause fatigue,palpitation, dyspnea or angina. Grade Ⅱ: the physical activity of patients withheart disease are mild restrictions, no symptoms at rest, but ordinary physicalactivity, there may be fatigue, palpitation, dyspnea or angina. Physical activityof patients with class III heart disease is significantly limited, less than theusual general activities that cause the above symptoms. Grade Ⅳpatients withheart disease can not engage in any physical activity. Symptoms of heart failure,resting after the increase in physical activity. Asked in detail about the patient’scondition after admission, the patient complained of heart functionclassification. Admitted to hospital the next day fasting venous plasmaepinephrine, norepinephrine. SPSS13.0statistical software for data processing.The measurement data were normally distributed with mean±standarddeviation, the skewness of the distribution of measurement data using themedian said. Normal distribution of measurement data between the two groupswith the unpaired t test, the relations between the measurement data usinglinear correlation analysis; skewed distribution of measurement data betweenthe two groups with the Wilcoxon rank sum test, the relations between themeasurement data using the Spearman rank correlation analysis; rate constitutecompared using the x2test. P <0.05was considered statistically significantdifference.Results：1. Epinephrine and norepinenephrine, in heart failure group and without heart group had a significant difference in patients(P＜0.05）;2. Heartfailure group before treatment was significantly higher than the anti-heartfailure treatment of heart failure improved plasma NE, E, the level differencebetween the two groups was significant (P <0.05);3. Heart failure group aftertreatment, plasma NE, E, level was significantly higher than the normal controlgroup, the difference between the two groups was statistically significant (P<0.05);4. Heart failure group was the poor cardiac function, plasma NE, E,increased more significantly, there was significant difference (P <0.05).Conclusion: The sympathetic nervous system activation, andcatecholamine concentrations increased as heart function worsens in thepathophysiological process of heart failure, therefore, elevated catecholaminelevels can be used as evaluation indicators of the degree of heart failure.