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دور هرمونات الاديبونكتيندور واللبتين والسايتوكينات لدى بعض المرضى المصابين بعجز القلب المزمن == Role Of Adiponectin Leptin&Other Cytokines In Some Chronic Heart Failure Patients
Author name:
نور نصير نافع
Supervisor name:
عدنان فاضل النجار | صباح موسى فاضل
General topic:
Medicine
Specific topic:
Clinical Biochemistry
Degree:
Master
University:
Mustansiriyah University - Faculty Of Medicine - Department Of Biochemistry
Language:
English
University location:
Baghdad
Key words:
- Adiponectin
- leptin
- cytokine
- Chronic Heart Failure
First pages:
19T1172 - p.pdf
Abstract:
عجز لقلب المزمن : حالة تقويضية معقدة متمثلة بمرحلة تشخيصية متقدمة مدمرة ونهائية. ان عملية انتقال المرض من مستقر الى دنف القلب(اعتلال عام مع هزال) ليست مفهومة جيدا, وهناك عدد من العمليات المختلفة للحفاظ من عملية الهدر، وهي في معظمها حيث وجدت لتكون في وقت م | Chronic Heart Failure(CHF)is a complex catabolic state that carries a devastating prognosis. The transmission from stable disease to cardiac cachexia is not well understood. A number of different mechanism maintain the wasting process, most of which were found to be activated early in the development of CHF.Many of these pathways are initially activated to protect heart from damage and to compensate for impaired myocardial function. Mediators that have been implicated in this process include pro - inflammatory cytokines like interleukin 1 and 6, tumour necrosis factor - ? and the acute phase protein (C.R - P)these cytokines are activated during the course of CHF and maintaining the wasting process. Little is known about the mechanism leading to cardiac cachexia (C.C).Adiponectin and leptin are a protein hormones derived from adipocytes and they are important regulator of energy metabolism and body weight. Previous studies of CHF and C.C , had great differences between cachectic and non - cachectic patients.OBJECTIVETo study the relationship between Adiponectin, leptin & cytokines in cachectic &non cachectic HF patients & compared the results with coronary artery disease( CAD) patients with preserved left ventricular systolic function( LVSF) &healthy control to elucidate their roles in pathobiochemistary of cachexia, & to study the prognostic power of adiponectin in CHF, also to identify & confirm the role of proinflammatory cytokine(IL - 6& TNF - ?)& systemic inflammation marker (C - R.P)in the progression of CHF to cardiac cachexia.SUBJECTS &METHODE Studies were performed in Cardiology Clinics in Ibn Al - Betar hospital for cardiac surgery. Eighty eight subjects were divided into four groups each contain 22 subjects are enrolled in this study : 1st group : patient with HF(reduce LVSF)with cachexia include 5 females &17 males with age range from 47 - 76 years;2nd group : patients with HF(reduce LVSF)but without cachexia include 6 females& 16 males with age range from 34 - 70 years;3rd group : patients with CAD (preserved LVSF)include 11 males &11 females with age range from35 - 80 years & 4th group : consisted of healthy controls include 11male s& 11 females with age range from 36 - 65 years. The hormonal assay was done by ELISA.RESULTSPatients with CHF with cachexia had significantly higher concentrations of adiponectin than all other groups(p=0.004) ,that are associated with significant decrease in serum level of leptin(p=0.002), significant increase in serum level of IL - 6 when compared to other groups (p=0.0001)& significant increase in number of C - R.P positive compared only to healthy control(p=0.007),but serum level of TNF - ? is significantly decrease when compared to both CAD(p=0.023) &healthy control (p=0.0001)although it was non - significant decrease when comper to patient with CHF without cachexia.In the patient with CHF without cachexia, non - significant increase in serum level of adiponectin (when compared to patient with CAD with preserved LVSF& non - significant decrease compare to healthy control), while serum level of leptin was non - significantly decrease (when compared to patient with CAD with preserved LVSF & non - significant increase when compared to healthy control) associated with non - significant decrease in serum level of TNF - ? in comparison to CAD with preserved LVSF but significant decrease compared healthy control(p=0.011)while serum level of IL - 6 significantly increase in comparison to both CAD with preserved LVSF(p=0.01) &healthy control(p=0.008).In CAD with preserved LVSF non - significant decrease in serum level of adiponectin,while non - significant increase in serum level of both leptin , IL - 6 & TNF - ? when compared to healthy control. In this study there is strong significant positive correlation between adiponectin & TNF - ? in patients with CAD with preserved LVSF(r=0.615,p=0.002); while adiponectin was positively correlated with E.F% in patients with CAD with preserved LVSF(r=0.448,p=0.037).Finally there is significant positive correlation between TNF - ? & IL - 6 in patients with CHF with cachexia(r=0.466,p=0.029).CONCLUSIONCachexia, is a catabolic state of CHF associated with increase in serum adiponectin concentration, this may be consider as preservation of physical response to the changes in body fat but might also suggest that adiponectin plays a role in pathogenesis of cachexia, while cachexia associated with HF is not caused by enhance leptin release but, by increased level of adiponectin which is powerful predictor of cardiac cachexia.Cardiovascular Disease(CVD) is associated with elevated marker of systemic inflammation)C - R.P(that plays important role in disease progression& increase level of proinflamnmatory cytokine)IL - 6(has been reported as important pathogenic factor contributed to cardiac injury during CHF& progression to cardiac cachexia, although ,the level of TNF - ? is lower & has no relation to the degree of cachexia
