Научная статья на тему 'Disorders of neurohumoral factors in patients with chronic heart failure'

Disorders of neurohumoral factors in patients with chronic heart failure Текст научной статьи по специальности «Медицина и здравоохранение»

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CHRONIC HEART FAILURE / NEUROHUMORAL FACTORS / NATRIURETIC PEPTIDE / ALDOSTERONE

Аннотация научной статьи по медицине и здравоохранению, автор научной работы — Avezov Davlat Kurbanbaevich, Nuritdinov Nuriddin Anvarhodjaevich

The aim of the study was to of neurohumoral factors in patients with chronic heart failure (CHF) in 64 patients with chronic heart failure (CHF) in the II-III functional class (FC). In patients with CHF FC II dominated mid-high levels of neurohumoral factors, whereas in patients with FC III noted the predominance of high levels of BNP and aldosterone.

Похожие темы научных работ по медицине и здравоохранению , автор научной работы — Avezov Davlat Kurbanbaevich, Nuritdinov Nuriddin Anvarhodjaevich,

Текст научной работы на тему «Disorders of neurohumoral factors in patients with chronic heart failure»

Section 7. Medical science

Avezov Davlat Kurbanbaevich, Nuritdinov Nuriddin Anvarhodjaevich, Tashkent medical academy, Uzbekistan E-mail: doctorlightmed@mail.ru

Disorders of neurohumoral factors in patients with chronic heart failure

Abstract: the aim of the study was to of neurohumoral factors in patients with chronic heart failure (CHF) in 64 patients with chronic heart failure (CHF) in the II—III functional class (FC). In patients with CHF FC II dominated mid-high levels of neurohumoral factors, whereas in patients with FC III noted the predominance of high levels of BNP and aldosterone. Keywords: chronic heart failure, neurohumoral factors, natriuretic peptide, aldosterone.

Chronic heart failure (CHF) is not only a medical but also a social challenge due to significant prevalence, high mortality rates. Prognosis in the patients with CHF is extremely unfavorable. It is expected that the nearest 20-30 years CHF incidence will rise in 40 -60%. This pathology sharply worsens the quality of life of patients and increases the risk of death in 4 times: it can vary from 15 to 50% during a year. The risk of sudden death in patients with CHF is 5 times higher than in those without heart failure [1; 2]. Thereby, a great interest to search for universal laboratory and instrumental markers of heart failure which are involved in the formation of pathogenic mechanisms of chronic heart failure in persons after myocardial infarction, is important in the processes of cardiovascular system remodeling, their early diagnosis, monitoring of therapy and prognosis of patients with CHF [3; 4]. Multicenter randomized studies showed that the development of LV dysfunction at the early stages occurs neurohumoral systems activation with increased activity of the sympathetic-adrenal system (SAS), which contributes to the activation of the renin-angiotensin-aldosterone system (RAAS), and other neurohormones and mediators including cytokines, endothelin, natriuretic peptide system (NUP), neurohormones and other mediators [5; 6]. Greater predictive value is the definition of NUP levels in blood. Large randomized clinical trials conducted in Europe and the USA — BAT-TLESCARRED, CONSENSUS II was noted increased death rate in patients with myocardial infarction who had NUP high level in blood at MI acute stage. Results ofmulticenter studies — The STARS-BNP Trial, HABIT Trial showed that to determine the level of BNP can not only exclude heart failure (HF), but also to confirm the diagnosis [7; 8]. Another neurohormone — aldosterone interacting with receptors of fibroblasts, endothelial cells and renal glomeruli leads to increased synthesis of collagen, fibrosis, proliferation of endothelium, remodeling NIJ-vascular and myocardial, stimulates apoptosis of cardiomyocytes, which have an important role in the formation of chronic cardiac dysfunction [9; 10].

Purpose of research was to study of neurohumoral factors in patients with chronic heart failure (CHF) in functional classes II-III.

Material and Methods. This investigation included 64 males with ischemic heart disease (IHD) associated with FC II (30) and III (34) CHF (mean age 53.5± 5.1 years). Control group comprised of 14 healthy persons (mean age 44.1±3.7 years). The patients were randomized into groups in relation to FC CHF by classification of New-York Association of cardiologists on the basis of findings of the six-minute walk test (SWT) and by scale for evaluation of clinical state of the patients (SECS).

To compare the data of BNP and aldosterone plasma levels we surveyed 14 healthy men (control group) who were being treated at other departments of the hospital, matched by sex, age and weight with the examined groups. Neurohumoral status of the patients was studied by plasma concentrations of brain natriuretic peptide (BNP) and aldosterone, which were determined in plasma at base-

line and after 6 months of therapy. Determining the level of BNP and aldosterone was performed on ELISA immunoassay analyzer using reagents of company «Biomedica».

The study obtained data were subjected to statistical processing on a PC Pentium-IV using the software package Microsoft Office Excel-2012, including the use of built-in functions of the aggregation. The variation methods used parametric and nonparametric statistics with taking the arithmetic average of the studied indicator (M), an average quadratic deviation (a), the standard errors of the mean (m), the relative values frequency,%), the statistical significance measurements obtained by com-paring the average values determined by Student (t) with the computation of the error probability (P) for testing normality (by kurtosis criterion) and the equality of the population variance (F — Fisher's exact test). For statistically significant changes were taken confidence level P <0.05. Statistical significance for qualitative variables was calculated using the x2 criterion (chi-square) and the z-criterion (Glanz). For dependency analysis features the Pearson correlation coefficient of pair (r) was calculated.

Results and Discussion. Analysis of the study results showed that patients with CHF, activation of the neurohumoral factors were marked which characterized by increasing concentrations of BNP and aldosterone in all examined patients. Established that in CHF levels of BNP and aldosterone were significantly increased and these changes correlate with disease progression. Patients with FC II had increased amount of BNP by 181,8% (p<0,001), and patients with FC III by 319.5% (p<0,001) compared with the control group. Accordingly, BNP level was 2.8-fold in FC II and 4.1-folds higher in FC III, compared with the values of the control group. There was also a significant increase of aldosterone in both groups of patients: in patients with FC II, level of aldosterone increased by 36.8% (p<0,001) compared with the control group. In patients with FC III it was 66.4% (p<0,001). Aldosterone levels increased by 1,3-fold in FC II and 1.6-fold in FC III. There was a direct correlation between BNP and AL in patients with FC II, which made up r = +0,91, and FC III r = +0,98, in both cases, P<0,001. Fluctuations of BNP in patients with FC II ranged from 430.5 to 912.6 fmol/ml, and in patients with FC III from 675.5 to 1423.1 fmol/ml. Similar changes were observed while analyzing aldosterone level. Fluctuations of aldosterone in FC II were from 180.2 to 361.1 pg/ml, in FC III from 219.1 to 435.7pg/ml. In consideration of the changes of these indices, we study the distribution of the examined patients on basis of the content of the investigated hormone levels within the lower values of the median (mid-high level) and high values of the median (high level). Analysis of the study results showed that mid-high increase in BNP was noted in 54.3% of examined patients, aldosterone in 62.8% of patients. High level of BNP, i. e. values above the median, was observed in 45.7% and aldosterone — in 37,2% of patients with FC II CHF.

Assessment of professional risk of employees of fuel and energy complex at production and use of coal

Studying the distribution of patients by the level of increase in neurohumoral factors in patients with CHF FC III showed that this group had high levels of BNP increase — 57.6% and aldosterone — 63.6% of the patients with III FC.

Conclusion. In patients with CHF FC II dominated mid-high levels of neurohumoral factors, whereas in patients with FC III noted the predominance of high levels of BNP and aldosterone.

References:

1. Engelfriet P. M., Hoogenveen R. T., Boshuizen H. C., Baal van P. H. To die with of from heart failure: a difference that counts: is heart failure underrepresented in national mortality statistics?//Eur J Heart Fail. - 2011. - Vol. 13. - P. 377-38.

2. Fonarow G. C., Albert N. M., Curtis A. B., et al. Associations between outpatient heart failure process-of-care measures and mortal-ity//Circulation. - 2011. - Vol. 123. - P. 1601.

3. Ketchum E. S., Levy W. C. Establishing prognosis in heart failure: a multimarker approach//Prog Cardiovasc Dis. - 2011. - Vol. 54. - P. 86-96.

4. Allen L. A., Felker G. M. Multi-marker strategies in heart failure: clinical and statistical approaches//Heart Fail Rev. - 2010. - Vol. 15. - P. 343-349.

5. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC//Eur. Heart J. - 2012. - Vol. 33. - P. 1787-1847.

6. Emdin1 M., Vittorini S., Passino C. et al. Old and new biomarkers of heart failure//Eur J Heart Fail. - 2009. - № 11. - P. 331-335.

7. Kelder J. C., Cowie M. R., McDonagh T. A. et al. Quantifying the added value of BNP in suspected heart failure in general practice: an individual patient data meta-analysis//Heart. - 2011. - Vol. 97. - P. 959-963.

8. HOMAGE -Overcoming Heart Failure, an European challenge. 2013. www.homage-hf.eu,:http://www.inserm.fr

9. Montalescot G., Beygui F., Collet J-Ph. et all. High Plasma Aldosterone Levels on Admission Are Associated With Death in Patients Presenting With Acute ST- Elevation Myocardial Infarction//Circulation. - 2006. - Vol. 114. - P. 2604-2610.

10. Tomaschitz A., Pilz S., Ritz E. et all. Plasma aldosterone levels are associated with increased cardiovascular mortality: the Ludwigshafen Risk and Cardiovascular Health (LURIC) study//Eur. Heart J. - 2010. - Vol. 31. - P. 1237-1247.

Adilov Utkir Khalilovich Research Institute of sanitation, hygiene and occupational diseases of the Ministry of Health of the Republic of Uzbekistan, Laboratory of industrial toxicology and occupational health, laboratory head, senior researcher Laboratory of industrial toxicology and occupational health, laboratory head, senior researcher E-mail: polibiomed@mail.ru

Assessment of professional risk of employees of fuel and energy complex at production and use of coal

Abstract: The increased prevalence of chronic bronchitis among employees of the energy industry in Uzbekistan that are affected various industrial dust it is being officially carried to number occupational diseases ("chronic dust bronchitis"). Occupational incidence among employees of energy industry remains to one of the highest in the republic and almost by 7-8 times exceeding in general in the country.

Keywords: production factor, working conditions, coal, health, professional risk.

Introduction. Follow modernization and technical re-equipment in Uzbekistan of the Fuel and Energy Complex (FEC) in case of extraction and coal using in production of heat power receipt, demand from employers more careful observance of occupational health rules and workers health protection.

Uzbekistan has explored coal storage in number of 1900 million tons which composed 0,2% from the world reconnoitered coal storage, including: reddish black — 1853 million tons, stone — 47 million tons [1, 8-13]. Coal extraction, in generally concentrated in the near Tashkent (Angren Coal mine) of the carboniferous area of reddish black coal and the Gissaro-Darvaz stone coal basin (Baysun and Shargun fields), used generally for an energy purpose.

An annual average fuel balance by system of the State-ownedJoint Stock Company "Uzbekenergy" has composed: natural gas — 86,7%,

mazut — 10,26%, coal — 3,04%. At the same time a coal share in fuel and energy balance of the republic will be increased by 2021 from 3,9% to 12%. Now reddish black coal is arrived to the Angren and the New Angren thermal power plants (TPP) ofthe following structure: the lowest warmth of combustion (1900-2020) kcal/kg, humidity — (36-45)%, content on the working mass of fuel — a mineral component (25-35)%, sulfur (1,5-,8)%. A coal share in fuel balance of the the New Angren TPP has constituted 16,93%, and the Angren TPP — 54,62%. At the same time the specific fuel consumption on released electro and heat power, respectively, has constituted: the New Angren TPP — 389,4 goe/kWh and 167 kgoe/Gcal, and the Angren — 439,0 goe/kWh and 186,6 kgoe/Gcal [2].

It is known that sanitary and hygienic value of coal dust is determined by the changes caused in respiratory organs [3, 77-85].