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Effects of Fluvastatin on Serum sICAM-1 and sVCAM-1 in Patients with Heart Failure

Author: LiZheng
Tutor: ZhengXiaoMing
School: North China Coal Medical
Course: Internal Medicine
Keywords: Heart Failure Fluvastatin Cell adhesion molecule Intercellular adhesion molecule-1 Vascular cell adhesion molecule-1
CLC: R541.6
Type: Master's thesis
Year: 2009
Downloads: 18
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Abstract


Congestive heart failure (congestive heart failure, CHF) is a common cardiovascular system of a clinical syndrome, severe or end stage cardiovascular disease the leading cause of death in a variety of cardiovascular disease, the mortality rate is extremely high. The modern Pathophysiology view, there are two main factors in the occurrence of CHF, myocardial remodeling (ventricular remodeling) and neuroendocrine activation. After the initial myocardial injury, there is a variety of endogenous neuroendocrine and cytokine activation, and having a circulating levels and tissue levels rise, caused by vasoconstriction of cytokines and neuroendocrine start overexpression common trigger inflammation, accelerated apoptosis of myocardial cells. Neuroendocrine - the cytokine system's long-term, chronic activation promote cardiac remodeling and increased myocardial damage and deterioration of heart function, which, in turn, further activation of neuroendocrine - cytokine system, so a vicious circle, CHF deteriorating. Cell adhesion molecules (cell adhesion molecule, CAM) are a class of cells, cells with the extracellular matrix-producing adhesion mediated membrane surface glycoprotein. Mainly expressed in endothelial cells, white blood cells, platelets and vascular smooth muscle cell surface, little exists in a soluble form in plasma. Have an important role in a variety of physiological and pathological processes of embryonic development and differentiation, maintenance of normal tissue structure, inflammation and immune response, wound healing, blood coagulation and thrombosis and tumor invasion and metastasis. In vascular endothelial cells, microvascular endothelial cells and leukocyte adhesion and activation play an important role, to participate in the occurrence of many diseases, development. CAM has the function of important regulatory cells and cell interactions, may play an important role in the formation and progress in CHF. White blood cells, endothelial cells or other cell surface CAM can fall off into the blood to become soluble cell adhesion molecules (soluble cell adhesion molecules, sCAM). In recent years, the clinical and basic experimental studies have shown that the CHF process sCAM expression and plasma levels increased significantly, probably one of the reasons leading to the failure of the myocardial cells. So, of great significance to further study the molecular mechanisms of CHF CHF occurrence and development of fundamentally curb. A large number of domestic and international research has confirmed the presence of significant and lasting improvement of serum levels of various inflammatory cytokines in patients with CHF. Soluble intercellular adhesion molecule -1 (sICAM-1) and soluble vascular cell adhesion molecule -1 (sVCAM-1) is to study more in CHF CAM belongs to the immunoglobulin superfamily, has important regulatory cells and the function of the interaction between the cells, they play an important role in the activation of leukocytes to vascular endothelial cells, microvascular endothelial cells adhesion. ICAM-1 is neutrophil migration, aggregation, play cytotoxicity indispensable substances involved in the occurrence of many diseases, development. Myocardial cells under hypoxia, cytokines and other factors, the cell surface to generate a large number of ICAM-1, ICAM-1 ligand lymphocyte function-associated antigen (LFA-1) distribution in the neutrophil surface, this adhesion molecule The combination contributed to myocardial cells and neutrophil adhesion, then neutrophils play a cytotoxic activity, release cytolytic substances perforin induced myocardial necrosis. Statins addition to the lipid-lowering effects, does not depend on the cholesterol-lowering pleiotropic, such as anti-inflammatory response, improve endothelial function, plaque stabilization, anti-arrhythmic, inhibition of thrombosis, anti-fibrosis and inhibition of neuroendocrine activity also significantly reduce the incidence of cardiovascular events and mortality. A series of studies have found that statins significantly in the treatment of coronary artery disease and hyperlipidemia reduce serum sCAM level the same, but there is no domestic clinical studies of CHF patients vivo sCAM level impact of statins reported . In summary, progress with a lot of basic research and clinical trials, and the importance of the inflammatory response in CHF gradually been recognized. CHF process sICAM-1 and sVCAM-1 serum levels were significantly increased, suggesting that they are important information related to the immune system is activated and may be one of the important reasons leading to the failure of the myocardial cells. Reduce the over-expression of soluble cell adhesion molecules sCAM, reduce sCAM serum levels is important of the future the CHF treatment of countermeasures, and will certainly provide new ways of prevention and treatment of CHF. In this study, by observing the CHF patients taking Fluvastatin treatment serum sICAM-1 and sVCAM-1 levels before and after the change, and aims to explore Fluvastatin in the treatment of CHF. The purpose of this project is designed to observe the more clinical basis for the fluvastatin short-term treatment of CHF patients serum sICAM-1 and sVCAM-1 levels to explore Fluvastatin treatment of CHF, which provides diagnosis and treatment of CHF . June 2007 to July 2008, select Kailuan Limited Hospital of North China Coal Medical College of Cardiology, 70 cases of hospitalized patients with CHF All cases were to meet the Framinghan heart failure diagnostic criteria. Cardiac function NYHA class, heart function Ⅱ seven cases, 35 cases of grade III, Ⅳ grade 28 cases, 33 cases of all CHF patients with ischemic cardiomyopathy, hypertensive heart disease in 21 cases, 9 cases of senile valvular heart disease , seven cases of dilated cardiomyopathy. Eligible patients were randomly divided into two groups, the conventional treatment group (33 cases), the intervention group, 37 cases. All patients were excluded from diabetes, thyroid dysfunction, rheumatism, chronic obstructive pulmonary disease, cerebrovascular accident, acute myocardial infarction within 6 months, pregnancy, cancer, liver and kidney function is markedly abnormal diseases. Normal control group, 20 cases were selected from health, gender, age, and the other two groups no significant difference. CHF NYHA standards assessed cardiac function, were enrolled and underwent color Doppler ultrasound echocardiography and blood biochemical routine testing. Conventional treatment group, the routine use of diuretics, angiotensin-converting enzyme inhibitors (ACEI), digoxin, beta-blockers and other drugs for treatment, intervention group based on the addition of fluvastatin (trade name: Lescol, Novartis Pharma Co., Ltd.) 40mg per night 20:00 when medication observed two weeks. Before and after treatment to observe changes in the clinical signs and symptoms of CHF patients before and after treatment was measured in serum sICAM-1 and sVCAM-1 levels, and at the same time using the enzyme-linked immunosorbent assay (ELISA). All the information has been verified finishing with Excel 2003 building a database for statistical analysis using SPSS for Windows 13.0 statistical software. Measurement data are expressed as mean plus or minus standard deviation (x ± s) said. Each set of data first passes through the test of normality and homogeneity of variance times test, paired t-test was used to compare the before and after treatment, the groups were compared using two-sample t-test, and more were compared using one-way ANOVA, P lt; 0 05 differences statistically significant. Results Serum sICAM-1 and sVCAM-1 levels in patients with different causes of CHF was no statistical significance (P gt; 0.05); Serum sICAM-1 and sVCAM-1 in cardiac function grade Ⅳ was significantly higher than that of cardiac function II grade III patients (p lt; 0.05); heart function Ⅱ, Ⅲ grade no statistical significance (P gt; 0.05); All serum levels were higher than normal control group (p lt; 0.05); Serum sICAM-1 and sVCAM-1 levels in the conventional treatment group and the intervention group after treatment than before treatment decreased (p lt; 0.05), but dropped comparison between groups showed no statistical significance (P gt; 0.05). Conclusions of serum sICAM-1 and sVCAM-1 in CHF etiology unrelated. CHF serum levels of sICAM-1 and sVCAM-1 levels are mainly related to the degree of cardiac functional grading. 3 short-term plus fluvastatin treatment did not further reduce serum sICAM-1 and sVCAM-1 levels on the basis of conventional therapy in CHF.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Blood circulation failure
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